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Sample records for surgical aspirator a

  1. A computer model of soft tissue interaction with a surgical aspirator.

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    Mora, Vincent; Jiang, Di; Brooks, Rupert; Delorme, Sébastien

    2009-01-01

    Surgical aspirators are one of the most frequently used neurosurgical tools. Effective training on a neurosurgery simulator requires a visually and haptically realistic rendering of surgical aspiration. However, there is little published data on mechanical interaction between soft biological tissues and surgical aspirators. In this study an experimental setup for measuring tissue response is described and results on calf brain and a range of phantom materials are presented. Local graphical and haptic models are proposed. They are simple enough for real-time application, and closely match the observed tissue response. Tissue resection (cutting) with suction is simulated using a volume sculpting approach. A simulation of suction is presented as a demonstration of the effectiveness of the approach.

  2. A comparison of fine-needle aspiration, core biopsy, and surgical biopsy in the diagnosis of extremity soft tissue masses.

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    Kasraeian, Sina; Allison, Daniel C; Ahlmann, Elke R; Fedenko, Alexander N; Menendez, Lawrence R

    2010-11-01

    Biopsy tissue can be obtained through a fine needle, a wider coring needle, or through an open surgical incision. Though much literature exists regarding the diagnostic yield of these techniques individually, none compare accuracy of diagnosis in the same mass. We asked how the diagnostic accuracy of fine-needle aspiration, core biopsy, and open surgical biopsy compare in regard to identifying malignancy, establishing the exact diagnosis, and guiding the appropriate treatment of soft tissue masses. We prospectively studied 57 patients with palpable extremity soft tissue masses, performing fine-needle aspiration, followed by core biopsy, followed by surgical biopsy of the same mass. Open surgical biopsy was 100% accurate on all accounts. With regard to determining malignancy, fine-needle aspiration and core biopsy had 79.17% and 79.2% sensitivity, 72.7% and 81.8% specificity, 67.9% and 76% positive predictive value, 82.8% and 84.4% negative predictive value, and an overall accuracy of 75.4% and 80.7%, respectively. In regard to determining exact diagnosis, fine-needle aspiration had a 33.3% accuracy and core biopsy had a 45.6% accuracy. With regard to eventual treatment, fine-needle aspiration was 38.6% accurate and core biopsy was 49.1% accurate. In soft tissue mass diagnosis, core biopsy is more accurate than fine-needle aspiration on all accounts, and open biopsy is more accurate than both in determining malignancy, establishing the exact diagnosis, and the guiding appropriate treatment.

  3. Glioma Surgical Aspirate: A Viable Source of Tumor Tissue for Experimental Research

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    Perry F. Bartlett

    2013-04-01

    Full Text Available Brain cancer research has been hampered by a paucity of viable clinical tissue of sufficient quality and quantity for experimental research. This has driven researchers to rely heavily on long term cultured cells which no longer represent the cancers from which they were derived. Resection of brain tumors, particularly at the interface between normal and tumorigenic tissue, can be carried out using an ultrasonic surgical aspirator (CUSA that deposits liquid (blood and irrigation fluid and resected tissue into a sterile bottle for disposal. To determine the utility of CUSA-derived glioma tissue for experimental research, we collected 48 CUSA specimen bottles from glioma patients and analyzed both the solid tissue fragments and dissociated tumor cells suspended in the liquid waste fraction. We investigated if these fractions would be useful for analyzing tumor heterogeneity, using IHC and multi-parameter flow cytometry; we also assessed culture generation and orthotopic xenograft potential. Both cell sources proved to be an abundant, highly viable source of live tumor cells for cytometric analysis, animal studies and in-vitro studies. Our findings demonstrate that CUSA tissue represents an abundant viable source to conduct experimental research and to carry out diagnostic analyses by flow cytometry or other molecular diagnostic procedures.

  4. Ultrasonic Surgical Aspirate is a Reliable Source For Culturing Glioblastoma Stem Cells

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    Behnan, Jinan; Stangeland, Biljana; Langella, Tiziana; Finocchiaro, Gaetano; Murrell, Wayne; Brinchmann, Jan E.

    2016-01-01

    Glioma stem cells (GSCs) are thought to be the source of tumor growth and therapy resistance. To understand the biology of GSCs, and target these tumors therapeutically, we need robust strategies for in vitro expansion of primary GSCs. To date, tumor core biopsies have been the main established source of GSCs. Since these samples are used for diagnostic purposes, the available tissue for cell culture and therapeutic targeting can be limited. In addition, a core biopsy is usually taken from one part of the tumor, thus would be unlikely to represent intra-tumor heterogeneity. To overcome these problems, tissue fragments from all over the tumor can be collected using an ultrasonic aspirator during surgery, thus assembling a “global tumor biopsy”. Usually, this ultrasonic aspirate (UA) sample is considered as biological waste after operations. Here, we show that UA samples offer a large and reliable source of live cells. Similar to core biopsies, UA samples enriched for GSCs that differentiated into neural lineages, showed inter-individual variation of GSC markers, and induced tumors. Molecular profiling showed that UA samples cover tumor heterogeneity better than core biopsies. These results suggest that UA samples can be used to establish large scale cultures for therapeutic applications. PMID:27605047

  5. Aortic valve debridement by ultrasonic surgical aspirator: a word of caution.

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    Craver, J M

    1990-05-01

    Aortic stenosis was relieved in 11 patients by ultrasonic debridement of the valve and annulus, while 102 other patients underwent valve replacement for aortic stenosis during 1988. Debridement was selectively applied based on findings of small annulus size (19 mm or less) and extensive calcification. Additional patient characteristics were mean transvalvular gradient of 78 mm Hg, advanced age, and marked left ventricular hypertrophy. Six patients had no residual gradient and 5 others a mean gradient less than 10 mm Hg. There were no complications related to the debridement process. Intraoperative transesophageal Doppler echocardiography demonstrated improved leaflet mobility and elimination of the gradient in all patients and elimination of associated valvular insufficiency in 2 patients. Follow-up echocardiography demonstrated late onset of new valvular regurgitation in 5 patients that was progressive and required reoperation in 3. Thickened, hardened, and retracted valve leaflets with loss of central coaptation were found in all 3 patients who underwent reoperation. Ultrasonic debridement can effectively relieve aortic stenosis, provide an excellent immediate hemodynamic result, and decrease operative time. However, the early occurrence of aortic insufficiency in a high percentage of patients makes it an unacceptable alternative to valve replacement, and the technique should be abandoned as a treatment for severe calcific aortic stenosis.

  6. Subtyping of Non-Small Cell Lung Carcinoma in Fine Needle Aspiration Specimens: A Study of 252 Patients with Surgical Correlations

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    Beyhan Varol Mollamehmetoğlu

    2016-12-01

    Full Text Available Objective: Fine-needle aspiration (FNA cytology performed by either transthoracic or transbronchial procedures is an important approach to obtain tumor tissue for histological diagnosis. We investigated the accuracy of FNA in differentiating NSCLCs of adenocarcinoma from squamous cell carcinoma histological types to correlate cytological findings with histological features and immunohistochemistry confirmation in some cases. Methods: From 2010 to 2015, a total of 635 transbronchial needle aspirations or transthoracic needle aspirations were performed. 332 cases were diagnosed as NSCLC, with or without an indication of a specific subtype, while 303 cases were not diagnosed as NSCLC. Out of 332 cases diagnosed as NSCLC, 252 had a histological follow-up. Subsequently, histological samples included 161 surgical resections and 91 biopsies. In cases with histopathological diagnosis accompanied by FNA cytology, an immunohistochemical study was carried out and the diagnostic results of the two methods were compared to each other. Results: The specific subtype of NSCLC was provided in 217 cases (86% based on cytomorphology which included 115 adenocarcinomas (46% and 102 squamous cell carcinomas (40%. The diagnosis NSCLC-NOS by FNA was set in 35 cases. At histology, 251 cases (99.6% were sub-classified: 122 adenocarcinomas (48%, 104 squamous cell carcinomas (41%, 11 large cell carcinomas (4% , and 14 adenosquamous carcinomas (6%. Agreement between cytological and histological typing was found in 181 of 197 cases (92% (K=0.837; p<0.001. Conclusion: Our study proved that most NSCLC can be sub-classified as adenocarcinoma or squamous cell carcinoma by FNA through cytomorphology and the application of immunocytochemistry.

  7. A reappraisal of the role of Gram's stains of tracheal aspirates in guiding antibiotic selection in the surgical intensive care unit.

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    Namias, N; Harvill, S; Ball, S; McKenney, M G; Sleeman, D; Ladha, A; Civetta, J

    1998-01-01

    Tracheal aspirate Gram's stains are used to guide antibiotic selection in empiric pneumonia treatment in the surgical intensive care unit (SICU). We questioned whether Gram's stains predict the organism cultured. A retrospective review of prospectively collected data. Gram's stains correlated with the cultured organism in 284 of 543 (52%) SICU cultures and in 226 of 403 (56%) trauma intensive care unit (TICU) cultures. Gram-negative rod (GNR) stains yielded GNR organisms in 182 of 205 (89%) SICU cultures and in 160 of 176 (91%) TICU cultures. Gram-positive coccus (GPC) stains yielded GPC organisms in 75 of 228 (33%) SICU cultures and in 52 of 149 (35%) TICU cultures. Noncorrelates in the GPC group were predominantly GNRs (185 of 250 (74%)). When the clinical decision has been made that empiric antibiotic coverage is necessary, GNR coverage should be instituted regardless of Gram's stain result. The decision to institute GPC coverage needs to be supported by clinical data other than the Gram's stain.

  8. Cervical priming with misoprostol before manual vacuum aspiration versus electric vacuum aspiration for first-trimester surgical abortion.

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    Mittal, Suneeta; Sehgal, Rohini; Aggarwal, Sagarika; Aruna, Janaki; Bahadur, Anupama; Kumar, Guresh

    2011-01-01

    To compare the efficacy of manual vacuum aspiration (MVA) with electric vacuum aspiration (EVA) and to evaluate whether cervical priming with misoprostol facilitates cervical dilation and reduces complications associated with first-trimester medical abortion performed up to 10 weeks of pregnancy. A total of 600 women who requested termination of pregnancy were randomized into 4 groups (150 women in each group). Group I and II received a vaginal placebo 3 hours before MVA or EVA, respectively. Group III and IV received 400 μg of vaginal misoprostol 3 hours before MVA or EVA, respectively. Complete abortion rates after MVA and EVA were both 97.9%; after cervical priming with misoprostol complete abortion rates were 98.6% versus 97.3% after cervical priming with placebo (P>0.05). Administration of misoprostol into the vagina before MVA resulted in 99.3% complete abortions (P=0.40), and the least operative blood loss, operating time, and need for cervical dilation (P0.05). For surgical evacuation, EVA and MVA did not differ in efficacy. Cervical priming 3 hours before MVA for termination of pregnancy significantly reduced the need for cervical dilation and the operative time, and improved the efficacy of the procedure. Pretreatment with vaginal misoprostol before MVA is a safe and effective method for terminating pregnancies of up to 10 weeks of gestation. CTRI/2009/091/000008. Copyright © 2010 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

  9. [Iatrogenic extravasations of cytotoxic or hyperosmolar aqueous solutions. Value of surgical emergency by aspiration and lavage].

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    Lambert, F; Couturaud, B; Arnaud, E; Champeau, F; Revol, M; Servant, J M

    1997-08-01

    Iatrogenic extravasations are characterized by their unpredictable course, the possible repercussions of functional, cosmetic and psychological sequelae, and the absence of a therapeutic consensus. The authors present the protocol used in Hôpital Saint-Louis, based on a synthesis of current procedures, consisting of emergency conservative surgical aspiration and lavage, performed in a context of close collaboration with oncolosits, intensive care physicians and radiologists. From 1994 to March 1997, fifteen patients were operated following extravasation during seven chemotherapeutic protocols, three radiographic examinations with injection of contrast agents and five resuscitation procedures. This simple protocol, applied systematically, achieved cure without cutaneous or functional sequelae in all patients. Aspiration-lavage during the first twelve hours therefore constitutes the treatment of choice of iatrogenic extravasation with cytotoxic or hyperosmolar aqueous solutions.

  10. Applying a Typology to Vocational Aspirations.

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    Holland, John L.; Gottfredson, Gary D.

    The psychological meaning and predictive value of a person's vocational aspirations were examined by applying Holland's typology to the vocational aspirations of high school juniors (N=1,005), college juniors (N=692), employed adults (N=140), and a second sample of college students studied over a 1 year interval (N=624). The aspirational data were…

  11. Fine Needle Aspiration Cytology of Thyroid Nodules: Correlation with Surgical Histopathology Histopathology

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    Nargess Ghazaleh

    2008-01-01

    Full Text Available Objective: Approximately 7% of people have thyroid nodules. The most important consideration in evaluating patients with thyroid nodules is whether the nodule is malignant. Fine needle aspiration (FNA biopsy is the best, safest, and most cost-effective measure for distinguishing malignancy, thus preventing unnecessary surgeries. In this survey, adequacy of smears, cytologic findings, histologic findings, and their concordance, have been studied. Materials and Methods: FNA biopsy was performed in 200 patients with palpable thyroid nodules in 2004-2005. Cytologic findings and adequacy of specimens were recorded. Of the 200 patients, 39 had surgery; postoperative histological results were compared with FNA biopsy results.Results: Of FNA smears, 88% were adequate; of these adequate smears, 57.2% were benign, 34.2% were suspicious for malignancy, and 8.6% were reported as malignant. When results of surgical pathology were compared with FNA cytology results, all benign surgical specimens also had benign cytology results, and all malignant surgical specimens had malignant results on cytology evaluation. In nodules with suspicious cytology, histopathology showed that 50% were malignant and 50% were benign.Conclusions: FNA is a simple and cost-effective procedure for identifying benign and malignant nodules. The incidence of malignant pathology in nodules with suspicious cytology was higher than other studies.Turk Jem 2008; 12: 73-4

  12. Percutaneous aspiration thromboembolectomy: a preliminary experience.

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    Murray, J G; Brown, A L; Wilkins, R A

    1994-08-01

    Percutaneous aspiration thromboembolectomy (PAT) is a radiological alternative to surgical embolectomy or thrombolysis in the treatment of acute arterial thromboembolic disease. We report our experience in eight patients aged 63-83 years (mean 71 years). Indications were graft thrombosis (1) or emboli from atrial fibrillation (3), abdominal aneurysm (2) or proximal angioplasty (2). PAT was performed at 10 arterial sites; common iliac (1), profunda femoris (1), superficial femoral (2), femoro-popliteal graft (1), popliteal (2) and arteries of the trifurcation (3). PAT was used as an adjunct to thrombolysis or angioplasty in five patients and as the sole procedure in three patients. It was successful in six patients (seven sites) with mean ABI rising from 0.4 pre- to 0.8 post-procedure. Two of the failures required amputations. One of these was a completely thrombosed dacron femoro-popliteal graft with poor run-off, and the second case had a failed surgical embolectomy prior to amputation. There were no major complications, and no mortality on follow-up at 1 month. PAT is a useful adjunct to thrombolysis and balloon angioplasty in the radiological treatment of acute thromboembolic disease. In patients in whom thrombolysis is contraindicated, it offers an alternative to surgical embolectomy.

  13. Thrombus aspiration catheter is a Dottering balloon.

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    Sheshagiri Rao, D; Barik, Ramachandra; Prasad, Akula Siva

    2016-01-01

    Coronary angiogram in a young man with history of STEMI with delayed presentation revealed subtotal occlusion of left anterior descending artery (LAD) with large thrombotic filling defect distal to the critical lesion. PCI was preferred without delay because of ongoing chest pain. Several runs of thrombus aspiration failed to detect any visible thrombus. However, the immediate angiogram after thrombus aspiration showed complete distal embolization of the thrombus which could have been achieved by Dottering or balloon dilatation. In contrary to the general perception, does thrombus aspiration push more thrombus than it can aspirate?

  14. Transbronchial and transesophageal fine-needle aspiration using a single ultrasound bronchoscope in the diagnosis of locoregional recurrence of surgically-treated lung cancer.

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    Sanz-Santos, José; Serra, Pere; Andreo, Felipe; Torky, Mohamed; Centeno, Carmen; Morán, Teresa; Carcereny, Enric; Fernández, Esther; García-Reina, Samuel; Ruiz-Manzano, Juan

    2017-02-28

    The present study sought to evaluate the usefulness of EBUS-TBNA in the diagnosis of locoregional recurrence of lung cancer in a cohort of lung cancer patients who were previously treated surgically, and describe our initial experience of EUS-B-FNA in this clinical scenario. We retrospectively studied the clinical records of all patients with a previous surgically-treated lung cancer who were referred to our bronchoscopy unit after suspicion of locoregional recurrence. The diagnostic sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and overall accuracy of EBUS-TBNA for the diagnosis of locoregional recurrence were evaluated. Seventy-three patients were included. EBUS-TBNA confirmed malignancy in 40 patients: 34 confirmed to have locoregional recurrence, six had metachronous tumours. Of the 33 patients with non-malignant EBUS-TBNA; 2 had specific non-malignant diseases, 26 underwent radiological follow up and 5 patients underwent surgery. Of the 26 patients who had radiological follow up; 18 remained stable, three presented thoracic radiological progression and 5 presented extrathoracic progression. Of the 5 patients who underwent surgery; 3 had metachronous tumours, one confirmed to be a true negative and one presented nodal invasion. Seven patients underwent EUS-B-FNA, four of them confirmed to have recurrence. The sensitivity, specificity, NPV, PPV and overall accuracy of EBUS-TBNA for the diagnosis of locoregional recurrence were 80.9, 100, 69.2, 100 and 86.6% respectively. EBUS-TBNA is an accurate procedure for the diagnosis of locoregional recurrence of surgically-treated lung cancer. EUS-B-FNA combined with EBUS-TBNA broads the diagnostic yield of EBUS-TBNA alone.

  15. Surgical closure of the larynx for intractable aspiration pneumonia: cannula-free care and minimizing the risk of developing trachea-innominate artery fistula.

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    Ise, Kazuya; Kano, Makoto; Yamashita, Michitoshi; Ishii, Show; Shimizu, Hirofumi; Nakayama, Kei; Gotoh, Mitsukazu

    2015-10-01

    There is a risk of developing a fatal trachea-innominate artery fistula following laryngotracheal separation for the prevention of intractable aspiration pneumonia. We developed a novel technique of surgical closure of the larynx to avoid this complication and provide long-term cannula-free care.

  16. Real time analysis of brain tissue by direct combination of ultrasonic surgical aspiration and sonic spray mass spectrometry.

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    Schäfer, Karl-Christian; Balog, Júlia; Szaniszló, Tamás; Szalay, Dániel; Mezey, Géza; Dénes, Júlia; Bognár, László; Oertel, Matthias; Takáts, Zoltán

    2011-10-15

    Direct combination of cavitron ultrasonic surgical aspirator (CUSA) and sonic spray ionization mass spectrometry is presented. A commercially available ultrasonic surgical device was coupled to a Venturi easy ambient sonic-spray ionization (V-EASI) source by directly introducing liquified tissue debris into the Venturi air jet pump. The Venturi air jet pump was found to efficiently nebulize the suspended tissue material for gas phase ion production. The ionization mechanism involving solely pneumatic spraying was associated with that of sonic spray ionization. Positive and negative ionization spectra were obtained from brain and liver samples reflecting the primary application areas of the surgical device. Mass spectra were found to feature predominantly complex lipid-type constituents of tissues in both ion polarity modes. Multiply charged peptide anions were also detected. The influence of instrumental settings was characterized in detail. Venturi pump geometry and flow parameters were found to be critically important in ionization efficiency. Standard solutions of phospholipids and peptides were analyzed in order to test the dynamic range, sensitivity, and suppression effects. The spectra of the intact tissue specimens were found to be highly specific to the histological tissue type. The principal component analysis (PCA) and linear discriminant analysis (LDA) based data analysis method was developed for real-time tissue identification in a surgical environment. The method has been successfully tested on post-mortem and ex vivo human samples including astrocytomas, meningeomas, metastatic brain tumors, and healthy brain tissue.

  17. FOREIGN BODY ASPIRATION: A CASE REPORT

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    Nafia Ozlem Kazanci

    2013-03-01

    Full Text Available Foreign body aspiration (FBA is common under 3 years of age. FBA can cause sudden respiratory failure. Furthermore, it leads to many respiratory system complications. Therefore, FBA is an important cause of mortality and morbidity for this age group. FBA cases are usually followed by diagnoses like pneumonia, bronchitis or bronchial asthma in the late period that history, clinical and laboratory findings suggesting foreign body aspiration can not be detected. We reported a 2-year-old male patient with pneumonia, who were administered various treatments. In thorax CT of this case, an image compatible with foreign body was seen in the right middle lobe-upper lobe separation area. Granulation tissue was detected in the entrance of the right main bronchus by rigid bronchoscopy and marked improvement occured in lung aeration after bronchoscopy. This case was reported to emphasize the importance of early diagnosis of foreign body aspiration because of high mortality and morbidity and the necessity of considering the foreign body aspiration in children with recurrent pulmonary infections. [J Contemp Med 2013; 3(1.000: 58-61

  18. Comparative cost-effectiveness of fine needle aspiration biopsy versus image-guided biopsy, and open surgical biopsy in the evaluation of breast cancer in the era of Affordable Care Act: a changing landscape.

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    Masood, Shahla; Rosa, Marilin; Kraemer, Dale F; Smotherman, Carmen; Mohammadi, Amir

    2015-08-01

    Proven as a time challenged and cost-effective sampling procedure, the use of FNAB has still remained controversial among the scientific community. Currently, other minimally invasive sampling procedures such as ultrasound guided fine needle aspiration biopsy (US-FNAB) and image guided core needle biopsy (IG-CNB) have become the preferred sampling procedures for evaluation of breast lesions. However, changes in the medical economy and the current growing emphasis on cost containment in the era of the Affordable Care Act make it necessary to stimulate a renewed interest in the use of FNAB as the initial diagnostic sampling procedure. This study was designed to define the changing trend in the practice of tissue sampling during the last several years, and to assess the comparative effectiveness and appropriateness of the procedure of choice for breast cancer diagnosis. After Institutional Review Board (IRB) approval, the computer database of the Pathology Department, University of Florida, College of Medicine-Jacksonville at UF Health was retrospectively searched to identify all breast biopsy pathology reports issued during the period of January 2004 to December 2011. The inclusion criteria were all women that underwent any of the following biopsy types: FNAB, US-FNAB, IG-CNB, and surgical biopsy (SB). Diagnostic procedures were identified using current procedural terminology (CPT) codes recorded on claims from the UF Health Jacksonville patient accounting application files. The data obtained was used to determine which technique has the best cost-effectiveness in the diagnosis of breast cancer. The outcome variable for this project was a positive breast cancer diagnosis resulting from these methodologies. The predictor variable was the biopsy type used for sampling. The rate of cancer detection for each procedure was also determined. Among the four groups of procedures compared, the lower cost was attributed to FNAB, followed by US-FNAB, and SB. IG-CNB was the most

  19. Performing a Better Bone Marrow Aspiration.

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    Friedlis, Mayo F; Centeno, Christopher J

    2016-11-01

    Bone marrow aspiration (BMA) is increasingly being used to harvest stem cells for use in regenerative medicine. The focus of BMA in interventional orthopedics is to maximize the yield of mesenchymal stem cells. The authors present an improved method for BMA that involves fluoroscope or ultrasound guidance combined with anesthesia; in the authors' experience, it produces the highest possible stem cell yield and is well tolerated by patients. The authors provide a step-by-step guide to the process, along with a discussion of technical and other considerations and quick reference guides for ultrasound- and fluoroscope-guided BMA. Copyright © 2016 Elsevier Inc. All rights reserved.

  20. Foreign Body Aspiration in Children-a Diagnostic Challenge

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    Slobodanka Petrovic

    2012-03-01

    Full Text Available The clinical presentation of foreign body aspiration in children is variable. Clinicians should maintain a high index of suspicion in order to make a prompt and correct diagnosis. In this paper,we present a case of foreign body aspiration that had gone unrecognized for 54 days. Foreign body aspiration should be considered whenever a previously healthy child suddenly exhibits unexplained symptoms usually consistent with airway obstruction which is refractory to medical treatment.

  1. Hepatic epithelioid hemangioendothelioma: A diagnostic pitfall in aspiration cytology

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    Gupta Ruchika

    2009-01-01

    Full Text Available Hepatic epithelioid hemangioendothelioma (EH is a rare vascular neoplasm. An accurate radiologic diagnosis is usually difficult due to the presence of multiple nodules, simulating metastatic carcinoma. Though histologic features of this tumor are well described, cytologic reports of hepatic EH are very few in the available literature. We describe a case of a young healthy adult male who was found to have multiple hepatic masses on radiologic investigations. A guided fine needle aspiration demonstrated a poorly differentiated neoplasm. The diagnosis was made on core biopsy assisted by immunohistochemistry, which showed characteristic features of EH. He is doing well 14 months after diagnosis, without surgical excision or chemotherapy. An accurate diagnosis of hepatic EH on aspiration cytology requires an adequate specimen and awareness of its cytologic features, including discohesive atypical cells with intracytoplasmic lumina and intranuclear inclusions. Since this tumor is usually unresectable but has a favorable prognosis as compared to hepatocellular carcinoma, a correct diagnosis is essential for appropriate management and prognostication.

  2. An aspiration material preparation system: application of a new liquid-based cytology technique for fine-needle aspiration of the breast.

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    Sakakibara, Eiichi; Kimachi, Setsuo; Hashimoto, Katsunori; Inagaki, Hiroshi; Nagasaka, Tetsuro; Wakusawa, Shinya; Yokoi, Toyoharu

    2011-01-01

    To evaluate the usefulness of our original liquid-based cell preparation system AMAPS (aspiration material preparation system) and to compare it with the AutoSmear system in breast aspiration cytology. A total of 487 specimens of fine-needle aspiration cytology of the breast were retrieved, of which 250 were processed with AMAPS and 237 with the AutoSmear method (before the introduction of AMAPS). A final histological diagnosis was obtained by an excisional biopsy or a surgical resection in 148 cases. Cell recovery rates were significantly improved with AMAPS (96.8 and 99.1% in Papanicolaou and Diff-Quik, respectively) compared with the AutoSmear method (40.9 and 42.3%, respectively; pcytology, the unsatisfactory rate decreased significantly (from 16.0 to 8.8%; pliquid-based cytology systems. Copyright © 2010 S. Karger AG, Basel.

  3. Management of pulmonary aspiration

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    Janda, Matthias; Scheeren, Thomas W L; Nöldge-Schomburg, Gabriele F E

    2006-01-01

    Pulmonary aspiration of gastric contents in the perioperative phase is associated with increased postoperative morbidity and mortality. For the management of aspiration, differentiation between acid-associated aspiration pneumonitis and aspiration pneumonia as a consequence of a secondary bacterial

  4. Cavitron ultrasonic surgical aspirator and visual evoked potential monitoring for chiasmal gliomas in children. Report of two cases.

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    Albright, A L; Sclabassi, R J

    1985-07-01

    The Cavitron ultrasonic surgical aspirator (CUSA) and intraoperative visual evoked potentials (VEP's) were found to be helpful in treating two children with difficult chiasmal gliomas. Approximately 60% of one tumor and 85% of the other was resected without change in the intraoperative VEP's and with no change in postoperative visual fields or acuity. The CUSA-VEP technique is useful in the infant to "buy time" for brain maturation, delaying or obviating subsequent radiotherapy. This approach may be helpful in the older child to reduce the tumor burden for subsequent chemotherapy. Chiasmal gliomas can be subtotally resected with the CUSA while visual function is monitored by intraoperative VEP's.

  5. Treatment of cranial epidural hematoma in a neonate by needle aspiration of a communicating cephalhematoma.

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    Smets, Koenraad Jan; Vanhauwaert, Dimitri

    2010-05-01

    A newborn presented on day 15 of life with an epidural hematoma, extending through a diastatic sutura squamosa in an external cephalhematoma. There was no skull fracture. The cephalhematoma was punctured twice with 24-h interval, reducing both the cephalhematoma and the epidural component. In the absence of neurological signs or symptoms, aspirating a cephalhematoma to evacuate the communicating epidural hematoma in a newborn infant may avoid more invasive surgical intervention.

  6. Strategic Aspirations

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    Christensen, Lars Thøger; Morsing, Mette; Thyssen, Ole

    2016-01-01

    Strategic aspirations are public announcements designed to inspire, motivate, and create expectations about the future. Vision statements or value declarations are examples of such talk, through which organizations announce their ideal selves and declare what they (intend to) do. While aspirations...... aspirations, in other words, have exploratory and inspirational potential—two features that are highly essential in complex areas such as sustainability and CSR. This entry takes a communicative focus on strategic aspirations, highlighting the value of aspirational talk, understood as ideals and intentions...

  7. Aspiration Alone, Aspiration Plus Steroid Injection and Aspiration Plus Ethanol Injection for Treatment of Dorsal Wrist Ganglions: A Comparative Study among Three Methods

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    Khandoker Abdur Rahim

    2016-01-01

    Full Text Available Background: There are varieties of treatment modalities to treat dorsal wrist ganglion cysts. But none of these has been the standard. So, we designed this study to compare among different treatment modalities. Objective: To compare the effects of aspiration alone, aspiration plus methylprednisone injection and aspiration plus ethanol injection into the dorsal wrist ganglions. Materials and Methods: This prospective study was performed in Dhaka Medical College Hospital, Dhaka from March 2010 to May 2011. Sixty six patients with dorsal wrist ganglions were treated in three groups –– aspiration alone in 24 patients (Group A, aspiration plus methylprednisolone injection into the cyst in 20 patients (Group B and aspiration plus ethanol injection, then reaspiration of the ethanol from the cyst after 3–5 minutes, in 22 patients (Group C. Elastic compression bandage was applied in all patients and recommended for 3 weeks. Follow-up was done at 1, 3, 6 and 12 months and conclusive assessment was done during final visit. Results: The success rate in Group A was seen in 9 patients (37.5%, in Group B in 11 (55% and in Group C in 14 (63.5% patients. The most frequent side-effect was pain during ethanol injection which was relieved by reaspiration of cyst. Conclusion: Injection of ethanol into the dorsal wrist ganglion was associated with higher success rate compared to aspiration and methylprednisolone injection. Further studies with larger sample size should be performed to assess the effect of ethanol injection in this disease.

  8. Dermal mass aspirate from a Persian cat.

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    Zimmerman, Kurt; Feldman, Bernard; Robertson, John; Herring, Erin S; Manning, Thomas

    2003-01-01

    A 1-year-old spayed female Persian cat with alopecia and weight loss had numerous variably ulcerated dermal nodules. Cytologic examination of an aspirate of one of the nodules revealed pyogranulomatous inflammation along with septate hyphae and basophilic round bodies, 0.5-1.0 microm in diameter, surrounded by a thin clear halo (arthrospores). The cytologic diagnosis was dermatophytic pseudomycetoma. Histologically, there were dermal granulomas containing poorly staining, septate hyphae with bulbous spores embedded within abundant amorphous eosinophilic material (Splendore-Hoeppli reaction), and the histologic diagnosis was pseudomycetoma-associated chronic multifocal severe granulomatous dermatitis with lymphocytic perifolliculitis and furunculosis. Microsporum canis was cultured from the lesion. Pseudomycetomas are distinguished from fungal mycetomas, or eumycotic mycetomas, by the findings of multiple lesions, lack of a history of skin trauma, an association with dermatophytes, most commonly Microsporum canis, and, histologically, lack of true cement material and a more abundant Splendore-Hoeppli reaction in pseudomycetomas. Additionally, pseudomycetomas differ from dermatophytosis, in which lesions are restricted to epidermal structures. Persian cats have a high incidence of pseudomycetoma formation, suggesting a heritable predisposition. The prognosis is fair with systemic antifungal therapy. When examining cytologic specimens from Persian cats with single or multiple dermal nodules, especially if pyogranulomatous inflammation is present, a diagnosis of pseudomycetoma should be suspected and is warranted if arthrospores and refractile septate hyphae are present.

  9. Pediatric foreign body aspiration: A nidus for Aspergillus colonization.

    Science.gov (United States)

    Mitchell, Candace A; Kreiger, Portia; Goff, Christopher; Shah, Udayan K

    2015-06-01

    We describe an immunocompetent child with bronchial fungus following foreign body aspiration. A two-year-old male presented with cough. Workup revealed air trapping and bronchoscopy showed aspirated foreign material in the right mainstem bronchus. Histopathology revealed fungal organisms suggestive of Aspergillus within an ulcer of the adjacent bronchial mucosa. Foreign body aspiration has been posited as a nidus for aspergilloma formation but is not yet described in the available English-language pediatric literature. Here, the foreign body provided a site for fungal growth in the bronchus of an otherwise healthy child. This case suggests that bronchial foreign body may pose risk of fungal colonization even in immunocompetent children.

  10. Nasocardiac reflex during aspiration and injection through a nasogastric tube: An infrequent occurrence.

    Science.gov (United States)

    Haldar, Rudrashish; Kaur, Jasleen; Bajwa, Sukhminder Jit Singh

    2015-04-01

    Nasocardiac reflex is a relatively less discussed variant of trigeminovagal reflex where the afferent arc of the reflex is represented by any of the branches of the trigeminal nerves, and the efferent arc is via the vagus nerve. Elicitation of this reflex is commonly seen during surgical manipulation and is manifested as bradycardia or even asystole. We report a case where nasocardiac reflex was unusually observed in a patient when aspiration and injection were done through a nasogastric tube.

  11. Food Particle Aspiration Associated with Hemorrhagic Shock: A Diagnostic Dilemma

    OpenAIRE

    Basheer Tashtoush; Jonathan Schroeder; Roya Memarpour; Eduardo Oliveira; Michael Medina; Anas Hadeh; Jose Ramirez; Laurence Smolley

    2015-01-01

    The hemodynamic compromise caused by a large aspirated food particle in the airway can become the focus of medical attention and a distraction from rare but fatal Heimlich maneuver related injuries after an incident of food aspiration. We herein present a case of an 84-year-old man who was brought to the emergency department after an episode of choking at a restaurant followed by several failed Heimlich maneuver attempts. Despite relieving the airway obstruction by extracting a large piece of...

  12. A Case of Bipolar Affective Disorder and Aspiration Pneumonia

    Directory of Open Access Journals (Sweden)

    Alessandro Gerada

    2013-01-01

    Full Text Available Adults with mental illness are at a higher risk of aspiration pneumonia than the general population. We describe the case of a patient with bipolar affective disorder and two separate episodes of aspiration pneumonia associated with acute mania. We propose that he had multiple predisposing factors, including hyperverbosity, sedative medications, polydipsia (psychogenic and secondary to a comorbidity of diabetes insipidus, and neuroleptic side effects.

  13. Cognitive correlates of adolescents' aspirations to leadership: a developmental study.

    Science.gov (United States)

    Singer, M

    1990-06-01

    The study examined age and gender differences in leadership aspirations among teenage adolescents. It was hypothesized that adolescents' valence, self-efficacy and attribution perceptions about leadership would be predictive of their aspirations to leadership. Altogether 52 fourth form and 78 seventh form high school students completed a questionnaire measuring (a) overall leadership aspirations, (b) 13 valence-instrumentality expectancies for 13 leadership outcomes, (c) self-efficacy perceptions, and (d) attributions of effective leadership. The results revealed significant gender differences in valence scores and significant age differences in self-efficacy and attribution measures. Regression analyses indicated that fourth formers' leadership aspirations were significantly predicted from their "ease-of-success" self-efficacy expectation; whereas seventh formers from either valence perceptions (males) or self-efficacy and attribution scores (females). These results were discussed in the context of the valence and self-efficacy models of career decision-making processes and attribution theory.

  14. Aspiration cytology of metastatic chordoma. A case report.

    Science.gov (United States)

    Elliott, E C; McKinney, S; Banks, H; Fulks, R M

    1983-01-01

    A patient with previously diagnosed sacrococcygeal chordoma presented with multiple skin nodules. Cytologic examination of an aspirate from one of these nodules showed syncytial clusters of hyperchromatic cells surrounded by extracellular mucin. The characteristic physaliphorous cells, although present in a biopsy of the primary sacrococcygeal tumor, were not observed in the aspirate or on histopathologic examination of three excised skin metastases. That chordoma metastases may lack physaliphorous cells should be recognized.

  15. CT-guided percutaneous aspiration of Tarlov cyst as a useful diagnostic procedure prior to operative intervention.

    Science.gov (United States)

    Lee, J-Y; Impekoven, P; Stenzel, W; Löhr, M; Ernestus, R-I; Klug, N

    2004-07-01

    Tarlov or perineural cysts are lesions of the nerve root most often found in the sacral region. Several authors recommend surgical treatment of symptomatic Tarlov cysts. However, successful surgical treatment is dependent on appropriate patient selection. In this article, we report three cases of a sacral perineural cyst, causing sciatic pain, and emphasize the usefulness of CT-guided percutaneous aspiration as an important diagnostic and prognostic procedure prior to definitive operative treatment.

  16. Physiological factors related to aspiration risk: a systematic review.

    Science.gov (United States)

    Steele, Catriona M; Cichero, Julie A Y

    2014-06-01

    Penetration-aspiration is considered the most serious component of oropharyngeal dysphagia. Clinicians regularly evaluate the pathophysiology of swallowing and postulate reasons or mechanisms behind penetration-aspiration. In this article we share the results of a two-stage literature review designed to elucidate the association between abnormalities in physiological measures of swallowing function and the occurrence of penetration-aspiration. In the first stage, a broad scoping review was undertaken using search terms for nine different structures involved in oropharyngeal swallowing. In the second stage, based on the results of the initial search, a more focused systematic review was undertaken which explored the association between aspiration and abnormalities in respiratory, tongue, hyoid, and laryngeal function in swallowing. A total of 37 articles underwent detailed quality review and data extraction in the systematic review. The results support measurement of tongue strength, anatomically normalized measures of hyoid movement, bolus dwell time in the pharynx while the larynx remains open, respiratory rate, and respiratory swallow phasing as parameters relevant to aspiration risk.

  17. A CASE OF INTRATONSILLAR ABSCESS MANAGED BY NEEDLE ASPIRATION

    Directory of Open Access Journals (Sweden)

    Jathin Sam

    2016-03-01

    Full Text Available Intratonsillar abscess is a rare complication of acute tonsillitis. It is a rarely diagnosed infection occurring in both children and adults. Herein, we present a case of intratonsillar abscess in a 25-year-old female patient, who was managed by needle aspiration which is a minimally invasive procedure and it is low cost, safe and effective along with antibiotic therapy. The aspiration of the pus from the tonsil confirms the diagnosis of intratonsillar abscess. So intratonsillar abscesses are uncommon, but should be considered in the differential diagnosis of peritonsillar abscess and tonsillitis.

  18. A microfluidic AFM cantilever based dispensing and aspiration platform

    NARCIS (Netherlands)

    Van Oorschot, R.; Perez Garza, H.H.; Derks, R.J.S.; Staufer, U.; Ghatkesar, M.K.

    2015-01-01

    We present the development of a microfluidic AFM (atomic force microscope) cantilever-based platform to enable the local dispensing and aspiration of liquid with volumes in the pico-to-femtoliter range. The platform consists of a basic AFM measurement system, microfluidic AFM chip, fluidic interface

  19. First-Year Student Aspirations: A Multinodal Analysis

    Science.gov (United States)

    Grellier, Jane

    2014-01-01

    This article explores the aspirations of first-year university students in a particular socio-geographic context, by juxtaposing this context with those of Western universities in the 1970s. The rhizomatic analysis enables student voices and personal narratives to complement, extend and undercut the words of published researchers and of the…

  20. Experimental Investigation of a High Pressure Ratio Aspirated Fan Stage

    Science.gov (United States)

    Merchant, Ali; Kerrebrock, Jack L.; Adamczyk, John J.; Braunscheidel, Edward

    2004-01-01

    The experimental investigation of an aspirated fan stage designed to achieve a pressure ratio of 3.4:1 at 1500 ft/sec is presented in this paper. The low-energy viscous flow is aspirated from diffusion-limiting locations on the blades and flowpath surfaces of the stage, enabling a very high pressure ratio to be achieved in a single stage. The fan stage performance was mapped at various operating speeds from choke to stall in a compressor facility at fully simulated engine conditions. The experimentally determined stage performance, in terms of pressure ratio and corresponding inlet mass flow rate, was found to be in good agreement with the three-dimensional viscous computational prediction, and in turn close to the design intent. Stage pressure ratios exceeding 3:1 were achieved at design speed, with an aspiration flow fraction of 3.5 percent of the stage inlet mass flow. The experimental performance of the stage at various operating conditions, including detailed flowfield measurements, are presented and discussed in the context of the computational analyses. The sensitivity of the stage performance and operability to reduced aspiration flow rates at design and off design conditions are also discussed.

  1. Operative hysteroscopy versus vacuum aspiration for incomplete spontaneous abortion (HY-PER): study protocol for a randomized controlled trial.

    Science.gov (United States)

    Huchon, Cyrille; Koskas, Martin; Agostini, Aubert; Akladios, Cherif; Alouini, Souhail; Bauville, Estelle; Bourdel, Nicolas; Fernandez, Hervé; Fritel, Xavier; Graesslin, Olivier; Legendre, Guillaume; Lucot, Jean-Philippe; Matheron, Isabelle; Panel, Pierre; Raiffort, Cyril; Fauconnier, Arnaud

    2015-08-19

    Incomplete spontaneous abortions are defined by the intrauterine retention of the products of conception after their incomplete or partial expulsion. This condition may be managed by expectant care, medical treatment or surgery. Vacuum aspiration is currently the standard surgical treatment in most centers. However, operative hysteroscopy has the advantage over vacuum aspiration of allowing the direct visualization of the retained conception product, facilitating its elective removal while limiting surgical complications. Inadequately powered retrospective studies reported subsequent fertility to be higher in patients treated by operative hysteroscopy than in those treated by vacuum aspiration. These data require confirmation in a randomized controlled trial comparing fertility rates between women undergoing hysteroscopy and those undergoing vacuum aspiration for incomplete spontaneous abortion. After providing written informed consent, 572 women with incomplete spontaneous abortion recruited from 15 centers across France will undergo randomization by a centralized computer system for treatment by either vacuum aspiration or operative hysteroscopy. Patients will not be informed of the type of treatment that they receive and will be cared for during their hospital stay in accordance with standard practices at each center. The patients will be monitored for pregnancy or adverse effects by a telephone conversation or questionnaire sent by e-mail or post over a period of two years. In cases of complications, failure of the intervention or diagnosis of uterine cavity disease, patient care will be left to the discretion of the medical center team. If our hypothesis is confirmed, this study will provide evidence that the use of operative hysteroscopy can increase the number of pregnancies continuing beyond 22 weeks of gestation in the two-year period following incomplete spontaneous abortion without increasing the incidence of morbidity and peri- and postoperative

  2. AngioVac Aspiration for Paradoxical Emboli Protection through a Fenestrated Fontan During Central Venous Thrombus Manipulation

    Energy Technology Data Exchange (ETDEWEB)

    Al-Hakim, Ramsey, E-mail: ralhakim@mednet.ucla.edu [University of California, Department of Radiology, Division of Interventional Radiology (United States); Patel, Komal, E-mail: kdpatel@mednet.ucla.edu [University of California, Department of Anesthesiology, Division of Cardiothoracic Anesthesiology (United States); Moriarty, John M., E-mail: jmoriarty@mednet.ucla.edu [University of California, Department of Radiology, Division of Interventional Radiology (United States)

    2015-06-15

    This case reports describes a 39-year-old female with a history of surgically repaired hypoplastic left heart syndrome who presented with a left peripherally inserted central catheter (PICC) with associated large volume subclavian and brachiocephalic vein thrombus. Due to the presence of a right-to-left shunt via a fenestrated Fontan, there was clinical concern for a paradoxical embolism during removal of the PICC. The AngioVac aspiration system was successfully utilized to aspirate thromboemboli from the level of the proximal Glenn shunt during manipulation and removal of the PICC. This is the first reported case to demonstrate the safe and effective use of the AngioVac aspiration system for protection of paradoxical emboli through a cardiac right-to-left shunt during a procedure at high risk for thromboembolism.

  3. Clinical audit of ultrasound guided fine needle aspiration in a general cytopathology service

    Directory of Open Access Journals (Sweden)

    Gunjan Mangla

    2015-01-01

    Conclusions: Reporting practices varied and did not conform to a uniform structure. The inadequacy rates of breast and thyroid aspirates were comparable to the rates in the literature. Comparable studies were not available for intra-abdominal aspirates.

  4. A Randomized Trial Among Compression Plus Nonsteroidal Antiinflammatory Drugs, Aspiration, and Aspiration With Steroid Injection for Nonseptic Olecranon Bursitis.

    Science.gov (United States)

    Kim, Joon Yub; Chung, Seok Won; Kim, Joo Hak; Jung, Jae Hong; Sung, Gwang Young; Oh, Kyung-Soo; Lee, Jong Soo

    2016-03-01

    Olecranon bursitis might be a minor problem in the outpatient clinic but relatively be common to occur. However, there are few well-designed studies comparing approaches to treatment. (1) Which treatment (compression bandaging with nonsteroidal antiinflammatory drugs [NSAIDs], aspiration, or aspiration with steroid injections) is associated with the highest likelihood of resolution of nonseptic olecranon bursitis? (2) Which treatment is associated with earliest resolution of symptoms? (3) What factors are associated with treatment failure by 4 weeks? We enrolled 133 patients from two centers; after applying prespecified exclusions (septic bursitis or concomitant inflammatory arthritis, intraarticular elbow pathology, recent aspiration or steroid injection done elsewhere, and refusal to participate), 90 patients were randomly allocated to receive compression bandaging with NSAIDs (C), aspiration (A), or aspiration with steroid injection (AS) groups (30 patients in each). The groups were similar at baseline in terms of age and gender. Seven patients (four from Group A and three from Group AS) were lost to followup. All patients were followed up weekly for 4 weeks, and the same treatment procedure was repeated if the bursitis recurred with any substantial fluid collection. At 4 weeks, the state of resolution and pain visual analog scale (VAS) were evaluated. Failed resolution was defined as presence of persistent olecranon bursal fluid collection at Week 4 after the initiation of the treatment; on the contrary, if bursal fluid collection was clinically reduced or completely disappeared by the end of Week 4, the treatment was considered successful. We compared the proportion of resolution by Week 4 and the median times to resolution among the treatment groups. In addition, we evaluated whether the resolution affected pain VAS and what factors were associated with the resolution. There were no differences in the proportion of patients whose bursitis resolved by Week 4

  5. FOREIGN BODY ASPIRATION IN CHILDREN: A HIDDEN DANGER

    OpenAIRE

    Marlene Rodrigues; Joana Teixeira; Patrícia Nascimento; Susana Carvalho; Augusta Gonçalves; José Almeida; Cristiana Ribeiro

    2016-01-01

    Introduction: Foreign body aspiration (FBA) is a common pediatric emergency and an important cause of accidental death in children. The majority of cases occur with small organic or inorganic objects in preschool age. FBA may be associated with a broad spectrum manifestations and its diagnosis represents a challenge. Case report: We report a case of a two-year-old child admitted in the emergency department with cough, dysphonia and dysphagia. On physical examination she had persistent coug...

  6. Food Particle Aspiration Associated with Hemorrhagic Shock: A Diagnostic Dilemma

    Directory of Open Access Journals (Sweden)

    Basheer Tashtoush

    2015-01-01

    Full Text Available The hemodynamic compromise caused by a large aspirated food particle in the airway can become the focus of medical attention and a distraction from rare but fatal Heimlich maneuver related injuries after an incident of food aspiration. We herein present a case of an 84-year-old man who was brought to the emergency department after an episode of choking at a restaurant followed by several failed Heimlich maneuver attempts. Despite relieving the airway obstruction by extracting a large piece of steak from the airway, the patient remained hypotensive and required continued hemodynamic support. Repeated laboratory tests within 24 hrs of aspiration showed a significant decline in the hemoglobin level. A computed tomography (CT scan of the abdomen and pelvis showed a lacerated liver with a large subcapsular hematoma draining into the pelvis. Conclusion. Hepatic rupture is a rare complication of Heimlich maneuver; this paper represents the second case report in the literature. It emphasizes the necessity of early identification and surveillance of fatal Heimlich maneuver complications in a high risk population.

  7. Food Particle Aspiration Associated with Hemorrhagic Shock: A Diagnostic Dilemma.

    Science.gov (United States)

    Tashtoush, Basheer; Schroeder, Jonathan; Memarpour, Roya; Oliveira, Eduardo; Medina, Michael; Hadeh, Anas; Ramirez, Jose; Smolley, Laurence

    2015-01-01

    The hemodynamic compromise caused by a large aspirated food particle in the airway can become the focus of medical attention and a distraction from rare but fatal Heimlich maneuver related injuries after an incident of food aspiration. We herein present a case of an 84-year-old man who was brought to the emergency department after an episode of choking at a restaurant followed by several failed Heimlich maneuver attempts. Despite relieving the airway obstruction by extracting a large piece of steak from the airway, the patient remained hypotensive and required continued hemodynamic support. Repeated laboratory tests within 24 hrs of aspiration showed a significant decline in the hemoglobin level. A computed tomography (CT) scan of the abdomen and pelvis showed a lacerated liver with a large subcapsular hematoma draining into the pelvis. Conclusion. Hepatic rupture is a rare complication of Heimlich maneuver; this paper represents the second case report in the literature. It emphasizes the necessity of early identification and surveillance of fatal Heimlich maneuver complications in a high risk population.

  8. Aspiration tests in aqueous foam using a breathing simulator

    Energy Technology Data Exchange (ETDEWEB)

    Archuleta, M.M.

    1995-12-01

    Non-toxic aqueous foams are being developed by Sandia National Laboratories (SNL) for the National Institute of Justice (NIJ) for use in crowd control, cell extractions, and group disturbances in the criminal justice prison systems. The potential for aspiration of aqueous foam during its use and the resulting adverse effects associated with complete immersion in aqueous foam is of major concern to the NIJ when examining the effectiveness and safety of using this technology as a Less-Than-Lethal weapon. This preliminary study was designed to evaluate the maximum quantity of foam that might be aspirated by an individual following total immersion in an SNL-developed aqueous foam. A.T.W. Reed Breathing simulator equipped with a 622 Silverman cam was used to simulate the aspiration of an ammonium laureth sulfate aqueous foam developed by SNL and generated at expansion ratios in the range of 500:1 to 1000:1. Although the natural instinct of an individual immersed in foam is to cover their nose and mouth with a hand or cloth, thus breaking the bubbles and decreasing the potential for aspiration, this study was performed to examine a worst case scenario where mouth breathing only was examined, and no attempt was made to block foam entry into the breathing port. Two breathing rates were examined: one that simulated a sedentary individual with a mean breathing rate of 6.27 breaths/minute, and one that simulated an agitated or heavily breathing individual with a mean breathing rate of 23.7 breaths/minute. The results of this study indicate that, if breathing in aqueous foam without movement, an air pocket forms around the nose and mouth within one minute of immersion.

  9. Riedel thyroiditis: Fine needle aspiration findings of a rare entity.

    Science.gov (United States)

    Weidner, Anna-Sophie; Molina, David; DeSimone, Robert A; Cohen, Marc A; Giorgadze, Tamar; Scognamiglio, Theresa; Hoda, Rana S

    2015-09-01

    Riedel thyroiditis is a rare fibrosing disorder characterized by extension of the fibroinflammatory process beyond the thyroid capsule. Due to the nature of this lesion, fine-needle aspiration often yields scant material and may be interpreted as non-diagnostic. In this report, we describe cytologic features that allow the cytopathologist to favor a diagnosis of Riedel thyroiditis, thereby guiding appropriate further work-up and management.

  10. Stereotactic aspiration versus craniotomy for primary intracerebral hemorrhage: a meta-analysis of randomized controlled trials.

    Directory of Open Access Journals (Sweden)

    Jia-Wei Wang

    Full Text Available BACKGROUND: A wealth of evidence based on the randomized controlled trials (RCTs has indicated that surgery may be a better choice in the management of primary intracerebral hemorrhage (ICH compared to conservative treatment. However, there is considerable controversy over selecting appropriate surgical procedures for ICH. Thus, this meta-analysis was performed to assess the effects of stereotactic aspiration compared to craniotomy in patients with ICH. METHODS: According to the study strategy, we searched PUBMED, EMBASE and Cochrane Central Register of Controlled Trials. Other sources such as the internet-based clinical trial registries, relevant journals and the lists of references were also searched. After literature searching, two investigators independently performed literature screening, assessment of quality of the included trials and data extraction. The outcome measures included death or dependence, total risk of complication, and the risk of rebleeding, gastrointestinal hemorrhage and systematic infection. RESULTS: Four RCTs with 2996 participants were included. The quality of the included trials was acceptable. Stereotactic aspiration significantly decreased the odds of death or dependence at the final follow-up (odds ratio (OR: 0.80, 95% confidence interval (CI: 0.69-0.93; P = 0.004 and the risk of intracerebral rebleeding (OR: 0.44, 95% CI: 0.26-0.74; P = 0.002 compared to craniotomy with no significant heterogeneity among the study results. CONCLUSIONS: The present meta-analysis provides evidence that the stereotactic aspiration may be associated with a reduction in the odds of being dead or dependent in primary ICH, which should be interpreted with caution. Further trials are needed to identify those patients most likely to benefit from the stereotactic aspiration.

  11. Vitiligo- A surgical approach

    Directory of Open Access Journals (Sweden)

    Deepti Ghia

    2012-01-01

    Full Text Available Aims and objective- To describe the spectrum of surgical modalities for stable vitiligo patients Methods- Patients having stable vitiligo since past 2 years with no improvement with medical line of treatment were enrolled for surgery after informed consent. Depending upon the size and location of vitiligo patch different modalities were performed. Suction blister, mini-punch grafting, split thickness skin grafting, trypsinised melanocyte-keratinocyte transfer and non-trypsinised melanocyte- keratinocyte transfer (Jodhpur technique and follicular grafting technique have been described photographically which have been performed at a tertiary care hospital. Conclusion- Vitiligo is often difficult to treat, stable patches resistant to medical line of management do respond to surgical treatment; however it is very important to choose the modality of surgery according location of the patch, size of the lesion and available resources.

  12. Laparoscopic hepatectomy by curettage and aspiration: a new technique

    Institute of Scientific and Technical Information of China (English)

    CAI Xiu-jun; LIANG Xiao; WANG Yi-fan; YU Hong; ZHENG Xue-yong; HUANG Di-yu; PENG Shu-you

    2007-01-01

    Background Laparoscopic surgery is advantageous for minimal invasiveness and rapid postoperative recovery. Since the use of laparoscopic hepatectomy in liver resection in the 1990s, it has been performed in a few institutions worldwide.Lack of efficient and safe techniques for liver transaction is the major obstacle preventing from its further development.We developed a new technique for laparoscopic hepatectomy by curettage and aspiration in 1998. In this paper we analyze the clinical outcomes of this technique after 7 years of practice.Methods Altogether 59 consecutive patients underwent laparoscopic hepatectomy by curettage and aspiration from August 1998 to January 2005 at our institution. These patients included 33 males and 26 females, with a mean age of 47 years. For liver transecsion laparoscopic Peng's multifunctional operative dissector (LPMOD) was used. Lesions included malignant liver tumors in 19 patients, benign liver tumors in 17, intrahepatic calculus in 18, and other liver lesions in 5.Procedures included local resections in 30 patients, left lateral segmentectomy in 28, and right hemihepatectomy in 1.Results Laparoscopic operation was completed in 57 patients. Two patients (3.4%) had the operation converted to laparotomy. The mean operating time was 143 minutes and the mean intraoperative blood loss was 456 mi. The mean length of postoperative hospital stay was 7 days. Complications occurred in 2 patients (3.4%), and there was no perioperative death.Conclusion Laparoscopic hepatectomy by curettage and aspiration is efficient and safe for liver resection.

  13. Aspiration of tracheoesophageal prosthesis in a laryngectomized patient

    Directory of Open Access Journals (Sweden)

    Conte Sergio C

    2012-08-01

    Full Text Available Abstract Background The voice prosthesis inserted into a tracheoesophageal fistula has become the most widely used device for voice rehabilitation in patients with total laryngectomy. Case presentation We describe a case of tracheoesophageal prosthesis’ (TEP aspiration in a laryngectomized patient, with permanent tracheal stoma, that appeared during standard cleaning procedure, despite a programme of training for the safe management of patients with voice prosthesis. Conclusions The definitive diagnosis and treatment were performed by flexible bronchoscopy, that may be considered the procedure of choice in these cases, also on the basis of the literature.

  14. Fine-needle aspiration biopsy: a historical overview.

    Science.gov (United States)

    Rosa, Marilin

    2008-11-01

    Fine needle aspiration biopsy is a safe, inexpensive and accurate technique for the diagnosis of benign and malignant conditions. Its increase in popularity in the present days has made it a technique used on daily basis in the majority of medical centers in United States and around the world. However, the situation was not always like this. In its beginnings the procedure suffered from all kinds of criticism and attacks. The purpose of this manuscript is to provide an overview about the development of this technique from its birth to our days.

  15. Concordance between HER-2 status determined by qPCR in Fine Needle Aspiration Cytology (FNAC) samples compared with IHC and FISH in Core Needle Biopsy (CNB) or surgical specimens in breast cancer patients.

    Science.gov (United States)

    Rodriguez, Claudia; Suciu, Voichita; Poterie, Audrey; Lacroix, Ludovic; Miran, Isabelle; Boichard, Amélie; Delaloge, Suzette; Deneuve, Jacqueline; Azoulay, Sandy; Mathieu, Marie-Christine; Valent, Alexander; Michiels, Stefan; Arnedos, Monica; Vielh, Philippe

    2016-11-01

    Determining the status of HER2-neu amplification and overexpression in breast cancer is crucial for prognosis but mostly for treatment purposes. Standard techniques include the determination of IHC in combination with in situ hybridization techniques to confirm a HER2-neu amplification in case of IHC2+ using either a core-needle biopsy or a surgical specimen. qPCR has been also demonstrated to be able to determine HER2 status, mostly in core biopsies or in surgical specimens. Fine-needle aspiration is a reliable, quicker and less invasive technique that is widely used for diagnosis of invasive breast cancer. In this study, we assessed the performance of qPCR in invasive breast carcinomas to determine HER2-neu status by using fine-needle aspiration samples and comparing to standard IHC and FISH. From a total of 154 samples from patients who had nodular breast lesions and attended the 1-day-stop clinic at the Gustave Roussy from March 2013 to October 2014, qPCR was able to determine the HER2 status in a mean of 3.7 days (SD 3.1). The overall concordance with standard HER2-testing was very high: 97% (95% CI 0.94 to 0.99); sensitivity was 96% (0.87-1), specificity 98% (0.95-1) and positive and negative predictive values 88% (0.75-1) and 99% (0.98-1), respectively. In conclusion, our study demonstrates that qPCR performed using fine-needle aspiration samples from a primary tumour is a reliable and fast method to determine HER2/neu status in patients with early breast cancer.

  16. Aspiration pneumonia

    Science.gov (United States)

    Anaerobic pneumonia; Aspiration of vomitus; Necrotizing pneumonia; Aspiration pneumonitis ... The type of bacteria that caused the pneumonia depends on: Your ... facility, for example) Whether you were recently hospitalized ...

  17. Fine needle aspiration biopsy diagnosis of metastatic neoplasms of the breast. A three-case report

    Directory of Open Access Journals (Sweden)

    Raquel Garza-Guajardo

    2005-09-01

    Full Text Available Abstract Metastases to the breast are unusual lesions that make up approximately 2% of all malignant mammary neoplasms and may mimic both benign and malignant primary neoplasms from a clinical point of view, as well as in imaging studies. Arriving at a correct diagnosis is therefore essential in order to establish appropriate management. We present three cases of metastatic neoplasms diagnosed through fine needle aspiration biopsy and immunocytochemistry. The cytological diagnoses were: medulloblastoma in an 18-year-old woman, melanoma in a 26-year-old man, and an exceptional case of ovarian sarcoma originating from a granulosa cell tumor with metastases to both breasts. A metastatic disease should be considered in the differential diagnosis of a palpable mass in the breast, especially if there is a history of an extramammary malignant neoplasm. Fine needle aspiration biopsy is the method of choice for the management of these cases. Whenever possible the exam of the material obtained should be compared to the previous biopsy, which is usually enough to arrive at a correct diagnosis, thus preventing unnecessary surgical procedures.

  18. Aspirated safety pin requiring thoracotomy: report of a case and review.

    Science.gov (United States)

    Causey, A L; Talton, D S; Miller, R C; Warren, E T

    1997-12-01

    Foreign body aspirations in children are relatively uncommon occurrences, but they can be a serious events, causing respiratory distress, atelectasis, chronic pulmonary infections, or death. Safety pins are not commonly aspirated objects and account for less than 3% of all foreign bodies found in the tracheobronchial tree. Fewer than 2% of patients require thoracotomy, and most aspirated materials can be removed by bronchoscopy, with low morbidity and mortality. A discussion of airway foreign bodies follows the presentation of a case of an older child who aspirated a safety pin, which required open thoracostomy for removal.

  19. A 5-year-old girl with a congenital ganglioneuroma diagnosed by fine needle aspiration biopsy: a case report

    Directory of Open Access Journals (Sweden)

    Ponce-Camacho Marco

    2008-01-01

    Full Text Available Abstract Introduction Ganglioneuroma is a rare, benign, neuroblastic tumor arising mainly from the central or peripheral autonomic nervous system, especially the sympathetic system. The most affected anatomical sites are the posterior mediastinum, retroperitoneum, adrenal gland and head and neck soft tissue. In the current literature, reports of ganglioneuroma diagnosed by fine-needle aspiration and its cytological appearance are scarce. Case Presentation A 5-year-old girl presented with a mass in the cervical region since birth. Laboratory routine tests were within normal limits, ultrasonography demonstrated a solid and well-circumscribed lesion in the soft tissues of the cervical region. Fine needle aspiration biopsy was carried out, and the obtained smears showed a mixture of mature ganglion cells and groups of spindle cells suggestive of schwann cell origin. A diagnosis of ganglioneuroma was suggested. Core biopsy and surgical resection confirmed this diagnosis. Conclusion Congenital ganglioneuroma of the cervical region is an uncommon soft tissue benign neoplasm of neuroblastic origin, and it should be considered in the differential diagnosis of head and neck pediatric soft tissue tumors. Fine needle aspiration biopsy technique is a reliable method that can be used with confidence when dealing with pediatric soft tissue tumors.

  20. Fine needle aspiration cytology of primary thyroid lymphoma: a report of ten cases

    Directory of Open Access Journals (Sweden)

    Gupta Nalini

    2005-12-01

    Full Text Available Abstract Primary lymphoma is an uncommon malignancy of the thyroid, comprising of 0.6 to 5 per cent of thyroid cancers in most series. Primary thyroid lymphomas (PTL occur most commonly in elderly women and are commonly of B- cell origin. These frequently present in clinical stage IE and IIE. We report here ten cases of PTL diagnosed over a period of about 7 years in our institute. Out of these ten cases, nine were diagnosed on fine needle aspiration cytology (FNAC and one case was misdiagnosed as lymphocytic thyroiditis. This case was diagnosed as Non- Hodgkin's lymphoma on surgical specimen. Five patients are disease free and doing well, while two died of disease and the other two were lost to follow-up. One patient is currently on chemotherapy. The salient clinical, biochemical, radiological features, FNA findings along with diagnostic difficulties are discussed.

  1. Aspiration cytology of ameloblastic fibroma: a diagnostic challenge.

    Science.gov (United States)

    Kumar, Neeta; Jain, Shyama

    2003-08-01

    Ameloblastic fibroma of the jaw is a rare, benign mixed odontogenic tumor, having little tendency for local invasion and a low recurrence rate. Cytologic distinction from ameloblastoma, ameloblastic fibrosarcoma, and intraosseous adenoid cystic carcinoma is necessary, in view of the different biologic behavior. A painful, slow-growing swelling of the jaw in a 5-yr-old child clinicoradiologically considered as a benign cystic lesion was aspirated. Sheets of small monomorphic epithelial cells with peripheral palisading by columnar cells were seen on cytology smears. The striking feature was central hyaline globules in some tubules. A cytologic possibility of adenomatoid odontogenic tumor was suggested. Histopathology, however, confirmed it to be an ameloblastic fibroma. Copyright 2003 Wiley-Liss, Inc.

  2. Effectiveness of chin-down posture to prevent tracheal aspiration in dysphagia secondary to acquired brain injury. A videofluoroscopy study.

    Science.gov (United States)

    Terré, R; Mearin, F

    2012-05-01

    The chin-down posture is generally recommended in patients with neurogenic dysphagia to prevent tracheal aspiration; however, its effectiveness has not been demonstrated. To videofluoroscopically (VDF) assess the effectiveness of chin-down posture to prevent aspiration in patients with neurogenic dysphagia secondary to acquired brain injury. Randomized, alternating, cross-over study (with and without the chin-down posture) in 47 patients with a VDF diagnosis of aspiration [31 stroke, 16 traumatic brain injury (TBI)] and 25 controls without aspiration (14 stroke, 11 TBI). During the chin-down posture, 55% of patients avoided aspiration (40% preswallow aspiration and 60% aspiration during swallow). The percentage was similar in both etiologies (58% stroke and 50% TBI). Fifty-one percent of patients had silent aspiration; of these, 48% persisted with aspiration while in the chin-down posture. A statistically significant relationship was found between the existence of pharyngeal residue, cricopharyngeal dysfunction, pharyngeal delay time and bolus volume with the persistence of aspiration. The chin-down posture did not change swallow biomechanics in patients without aspiration. Only half the patients with acquired brain injury avoided aspiration during cervical flexion; 48% of silent aspirators continued to aspire during the maneuver. Several videofluoroscopic parameters were related to inefficiency of the maneuver. Therefore, the indication for chin-down posture should be evaluated by videofluoroscopic examination. © 2012 Blackwell Publishing Ltd.

  3. Gastric reflux: association with aspiration and oral secretion pH as marker of reflux: a descriptive correlational study.

    Science.gov (United States)

    Schallom, Marilyn; Orr, James A; Metheny, Norma; Kirby, John; Pierce, Janet

    2015-01-01

    Gastric reflux leading to pulmonary aspiration is a frequent event in mechanically ventilated, gastric-fed patients, which can lead to ventilator-associated complications and pneumonia. The objectives of this study were to determine the association between gastric reflux and aspiration using the presence of pepsin in oral or tracheal secretions as a marker of reflux or aspiration and to determine the association between the pH (range, 0-14) and the presence of pepsin in oral secretions. A descriptive correlational study was conducted in mechanically ventilated surgical or medical patients receiving gastric tube feedings. Oral secretions were suctioned hourly and tracheal secretions every 2 to 3 hours for 12-hour periods over 1 to 2 days in 15 patients. There were 142 paired samples of oral tracheal secretions. A majority of samples (60%) had the same results, with 32% both pepsin-positive and 27% both pepsin-negative. The range of pH measurements was 4 to 8, with a mean of 6.3 ± 0.05. Ninety oral specimens had a pH of 4 to 6. Forty-seven of the oral specimens with pH measures between 4 and 6 (52%) were pepsin-positive. The correlation of pH percent pepsin-positive oral secretions was not significant. Aspiration events were more frequent than reflux events. Measurement of actual pepsin concentration to detect new reflux and aspiration events is recommended in future studies. Bedside pH measures of oral secretions are not a valid marker of gastric reflux.

  4. Surgical treatment of a large congenital cavernous hemangioma on the thorax of a foal

    DEFF Research Database (Denmark)

    Jacobsen, Stine; Christophersen, Mogens Teken; Tnibar, Aziz;

    2016-01-01

    A 3-day-old male foal was presented with a fluctuant 25 × 15 cm mass on the thorax. The mass had increased in size since birth. The mass did not respond to conservative treatment consisting of aspiration of serohaemorrhagic contents and compression bandages, and it was therefore surgically remove...

  5. Contrast-enhanced harmonic endoscopic ultrasound-guided fine-needle aspiration in the diagnosis of solid pancreatic lesions: a retrospective study.

    Science.gov (United States)

    Hou, Xiaojia; Jin, Zhendong; Xu, Can; Zhang, Minmin; Zhu, Jianwei; Jiang, Fei; Li, Zhaoshen

    2015-01-01

    The negative predictive value of endoscopic ultrasonography-guided fine needle aspiration for the diagnosis of solid pancreatic lesions remains low, and the biopsy specimens are sometimes inadequate for appropriate pathological diagnosis. To evaluate the usefulness of a novel method of contrast-enhanced harmonic endoscopic ultrasonography-guided fine-needle aspiration for the differential diagnosis and adequate sampling of solid pancreatic lesions. Patients with a diagnosis of solid pancreatic lesions who underwent fine-needle aspiration guided by contrast-enhanced harmonic endoscopic ultrasonography or by endoscopic ultrasonography from October 2010 to July 2013 were retrospectively identified and classified into the CH-EUS or EUS group, respectively. Surgical pathology and/or follow-up results were defined as the final diagnosis. Operating characteristics and adequacy of biopsy specimens by fine-needle aspiration were compared between the two groups. Operating characteristics for contrast-enhanced harmonic endoscopic ultrasonography-guided fine-needle aspiration in solid pancreatic lesions were as follows: area under the curve = 0.908, sensitivity = 81.6%, specificity = 100%, positive predictive value = 100%, negative predictive value = 74.1%, and accuracy = 87.9%. The percentage of adequate biopsy specimens in the CH-EUS group (96.6%) was greater than that in the EUS group (86.7%). Simultaneous contrast-enhanced harmonic endoscopic ultrasonography during fine-needle aspiration is useful for improving the diagnostic yield and adequate sampling of solid pancreatic lesions.

  6. The Influence of Major Ambition Resources on College Aspirations and Attainments: Toward a Comprehensive Model.

    Science.gov (United States)

    Spady, William G.

    This paper attempts to design a model that covers a comprehensive range of theoretically relevant variables that focus on the aspiration-attainment process. The discussion is in 4 parts. First, the concept of "ambition" is separated into theoretically and operationally distinct components. Second, educational aspiration and college attainments are…

  7. Arterial Bleeding of a Thyroid Mass After Thyroid Fine- Needle Aspiration Biopsy: A Case Report

    Energy Technology Data Exchange (ETDEWEB)

    Park, Chul Hi; Byun, Sung Su; Kim, Jeong Ho; Hwang, Hee Young; Kim, Ha Na; Chung, Dong Jin; Kim, Hyung Sik [Gachon University Gil Hospital, Incheon (Korea, Republic of)

    2009-06-15

    Thyroid fine needle aspiration biopsy is a very common procedure that is used to assess thyroid nodules; any complications from this procedure are rather rare. We report here on an unusual case of active bleeding with the formation of a large hematoma from a branch of the superior thyroidal artery, and this was caused by a thyroid fine needle aspiration biopsy. To the best of our knowledge, this is the first report of active arterial bleeding after thyroid fine needle aspiration biopsy. The active bleeding was successfully treated by interventional embolization

  8. Bone marrow aspiration

    Science.gov (United States)

    Iliac crest tap; Sternal tap; Leukemia - bone marrow aspiration; Aplastic anemia - bone marrow aspiration; Myelodysplastic syndrome - bone marrow aspiration; Thrombocytopenia - bone marrow aspiration; Myelofibrosis - bone marrow aspiration

  9. Critical evaluation of fine needle aspiration cytology as a diagnostic technique in bone tumors and tumor-like lesions.

    Science.gov (United States)

    Chakrabarti, Sudipta; Datta, Alok Sobhan; Hira, Michael

    2012-01-01

    Though open surgical biopsy is the procedure of choice for the diagnosis of bone tumors, many disadvantages are associated with this approach. The present study was undertaken to evaluate the role of fine needle aspiration cytology (FNAC) as a diagnostic tool in cases of bony tumors and tumor-like lesions which may be conducted in centers where facilities for surgical biopsies are inadequate. The study population consisted of 51 cases presenting with a skeletal mass. After clinical evaluation, radiological correlation was done to assess the nature and extent of each lesion. Fine needle aspiration was performed aseptically and smears were prepared. Patients subsequently underwent open surgical biopsy and tissue samples were obtained for histopathological examination. Standard statistical methods were applied for analysis of data. Adequate material was not obtained even after repeated aspiration in seven cases, six of which were benign. Among the remaining 44 cases, diagnosis of malignancy was correctly provided in 28 (93.3%) out of 30 cases and categorical diagnosis in 20 (66.67%). Interpretation of cytology was more difficult in cases of benign and tumor-like lesions, with a categorical opinion only possible in seven (50%) cases. Statistical analysis showed FNAC with malignant tumors to have high sensitivity (93.3%), specificity (92.9%) and positive predictive value of 96.6%, whereas the negative predictive value was 86.7%. FNAC should be included in the diagnostic workup of a skeletal tumor because of its simplicity and reliability. However, a definitive pathologic diagnosis heavily depends on compatible clinical and radiologic features which can only be accomplished by teamwork. The cytological technique applied in this study could detect many bone tumors and tumor-like conditions and appears particularly suitable as a diagnostic technique for rural regions of India as other developing countries.

  10. Core Needle Biopsy and Fine Needle Aspiration Alone or in Combination: Diagnostic Accuracy and Impact on Management of Renal Masses.

    Science.gov (United States)

    Cate, Frances; Kapp, Meghan E; Arnold, Shanna A; Gellert, Lan L; Hameed, Omar; Clark, Peter E; Wile, Geoffrey; Coogan, Alice; Giannico, Giovanna A

    2017-06-01

    Fine needle aspiration with and without concurrent core needle biopsy is a minimally invasive method to diagnose and assist in management of renal masses. We assessed the pathological accuracy of fine needle aspiration compared to and associated with core needle biopsy and the impact on management. We performed a single institution, retrospective study of 342 cases from 2001 to 2015 with small and large renal masses (4 or less and greater than 4 cm, respectively). Diagnostic and concordance rates, and the impact on management were analyzed. Adequacy rates for fine needle aspiration only, core needle biopsy only and fine needle aspiration plus core needle biopsy were 21%, 12% and 8% (aspiration vs aspiration plus biopsy p aspiration plus biopsy group adding aspiration to biopsy and biopsy to aspiration reduced the inadequacy rate from 23% to 8% and from 27% to 8% for a total reduction rate of 15% and 19%, respectively, corresponding to 32 cases (9.3%). Rapid on-site examination contributed to a 22.5% improvement in fine needle aspiration adequacy rates. In this cohort 30% of aspiration only, 5% of biopsy only and 12% of aspiration plus biopsy could not be subtyped (aspiration vs biopsy p aspiration vs aspiration plus biopsy p biopsy vs aspiration plus biopsy p = 0.06). The diagnostic concordance rate with surgical resection was 99%. Conversion of an inadequate specimen to an adequate one by a concurrent procedure impacted treatment in at least 29 of 32 patients. Limitations include the retrospective design and accuracy measurement based on surgical intervention. Fine needle aspiration plus core needle biopsy vs at least fine needle aspiration alone may improve diagnostic yield when sampling renal masses but it has subtyping potential similar to that of core needle biopsy only. Copyright © 2017 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  11. Ileus development in the trauma/surgical intensive care unit: a process improvement evaluation.

    Science.gov (United States)

    Phipps, Marcy; Bush, Jeffrey A; Buhrow, Dianne; Tittle, Mary B; Singh, Deepak; Harcombe, Julianne; Riddle, Evanthia

    2011-01-01

    Ileus development has been associated with a wide range of complications among hospitalized patients, ranging from increased patient pain and discomfort to malnutrition, aspiration, delayed rehabilitation, and sepsis. This article examines factors that appeared to correlate with an increase in ileus development among patients in a trauma/surgical intensive care unit, with the goal of preventing the condition through nursing practice changes.

  12. Weight loss and its relation to fat aspiration yields in liposuction: a survey in 48 patients.

    Science.gov (United States)

    Boeni, R

    2012-01-01

    Liposuction surgeons often observe individually fluctuating amounts of aspirated fat. In patients with sagging skin due to previous weight loss there is a tendency of decreased fat aspiration volumes. To study the influence of weight loss on fat aspiration volumes in a series of 48 patients. We matched individuals of the same gender, but with a different weight history from a vast number of patients who had undergone liposuction surgery. The aspirated fat to wetting solution ratio (FWR) of the circumferential abdominal region was evaluated in three groups: A - patients with no weight loss (n = 16; 8 males/ 8 females), B - patients with a history of moderate weight loss (weight loss 5-10% of body weight; n = 16; 8 males/8 females), and C - patients who had a massive weight loss prior to surgery (weight loss exceeding 15% of body weight; n = 16; 8 males/8 females). The aspirated FWR was 3.4 ± 0.5, 1.0 ± 0.3 and 0.4 ± 0.2 in groups A, B and C, respectively. The differences between the groups were statistically significant (p loss in regard to fat aspiration volumes compared to patients without prior weight loss. These findings point to the importance of a weight loss history prior to surgery. Regardless of lower fat aspiration yields in patients with massive weight loss, good results are still achievable. This is not only due to volume reduction but to skin tightening. Copyright © 2012 S. Karger AG, Basel.

  13. Disk battery aspiration in a young child: a scarcely reported phenomenon.

    Science.gov (United States)

    McLarty, Justin D; Krishnan, Miguel; Rowe, Mark R

    2012-07-01

    Disk (or button) battery ingestion is not uncommon, with an estimated US incidence of 2 to 8 per million annually.(1) Reported serious adverse sequelae include esophageal stenosis, tracheoesophageal fistula, vocal cord paralysis, massive bleeding, and death.(1,2) There are, however, surprisingly few reports of aspirated batteries in the searchable literature; we found only 2. We present the diagnostic workup and treatment of a previously healthy 4-year-old boy with an aspirated disk battery in the bronchus.

  14. Surgical area contamination--comparable bacterial counts using disposable head and mask and helmet aspirator system, but dramatic increase upon omission of head-gear: an experimental study in horizontal laminar air-flow.

    Science.gov (United States)

    Friberg, B; Friberg, S; Ostensson, R; Burman, L G

    2001-02-01

    The effect of different head coverings on air-borne transmission of bacteria and particles in the surgical area was studied during 30 strictly standardized sham operations performed in a horizontal laminar air flow (LAF) unit. The operating team members wore disposable gowns plus either a non-sterile head covering consisting of a squire type disposable hood and triple laminar face mask, a sterilized helmet aspirator system or no head cover at all. In the wound area both types of head cover resulted in low and comparable air (means of 8 and 4cfu/m(3)) and surface contamination (means of 69 and 126cfu/m(2)/h) rates. Omission of head-gear resulted in a three- to five-fold increase (P > or = 0.01- 0.001), depending on site sampled air contamination rate (mean of 22cfu/m(3)) whereas the bacterial sedimentation rate in the wound area increased about 60-fold ( P > or = 0.0001). A proper head cover minimized the emission of apparently heavy particles that were not removed by the horizontal LAF and contained mainly streptococci, presumably of respiratory tract origin. Dust particle counts revealed no differences between the three experimental situations. No correlation between air and surface contamination rates or between air contamination and air particle counts was found. We conclude that, from a bacteriological point of view, disposable hoods of squire type and face masks are equally as efficient as a helmet aspirator system and both will efficiently contain the substantial emission of bacteria-carrying droplets from the respiratory tract occurring when head cover is omitted. Finally, the use of bacterial air counts to assess surgical site surface contamination in horizontal LAF units must be seriously questioned.

  15. Solitary metastatic cancer to the thyroid: a report of five cases with fine-needle aspiration cytology

    Directory of Open Access Journals (Sweden)

    Batoroev Yuri

    2007-01-01

    Full Text Available Abstract Three men and 2 women with ages ranging from 37 to 70 years, clinically and histologically confirmed solitary, palpable metastatic cancers to the thyroid (SMCT and preoperative cytologic investigation of their thyroid lesions by fine-needle aspiration (FNA, were reviewed. Four patients were known to have a solid cancer treated by radical surgery 1 to 4 years prior [1 bronchogenic squamous cell carcinoma, 1 parotid adenoid cystic carcinoma, 1 renal cell carcinoma (RCC and 1 cutaneous melanoma], and 1 patient had no past history of cancer. Direct smears prepared from the patients' thyroid FNAs were fixed in 95% ethanol and stained with the Papanicolaou method. In 3 cases, immunostaining of the aspirated tumor cells with thyroglobulin antibody was performed, and in 1 case an aspiration smear was stained with commercial HMB-45 antibody. A correct cytodiagnosis of metastatic cancer to the thyroid was made in all 5 cases. In 1 patient the thyroid FNA revealed a metastatic RCC that led to the discovery of a clinically occult RCC. All 5 patients died of metastatic disease 27 to 40 months after surgical resection of their SMCTs.

  16. Entonox as a sedative for bone marrow aspiration and biopsy.

    Science.gov (United States)

    Gudgin, E J; Besser, M W; Craig, J I O

    2008-02-01

    Bone marrow aspiration and biopsy can be a painful procedure. Sedation techniques may make this investigation more acceptable to patients, but have the potential to cause life-threatening complications, as well as requiring additional staff and equipment for safe administration. We assessed the use of Entonox, a 50 : 50 mix of nitrous oxide and oxygen, as a sedation and analgesic agent, and compared it to previous experience with the intravenous (i.v.) benzodiazepine midazolam. Patients' perception of pain, and both the operator and patient's views on the ease of the procedure and safety factors were recorded. Twenty-two patients who had previously required i.v. midazolam sedation (16), or who requested sedation (6) were studied. Fifteen of 16 (94%) found Entonox better or equal to midazolam, and only one patient (6%) found it worse. There were no serious adverse events due to Entonox. We have shown, in this small group of patients, that Entonox is an effective, safe alternative to intravenous midazolam for sedation during bone marrow biopsy, and is considered acceptable by both patients and staff. It has the major advantage that no additional staff or facilities are required for safe administration or monitoring the patient during or after the procedure.

  17. Optimal timing for a repeat fine-needle aspiration biopsy of thyroid nodule following an initial nondiagnostic fine-needle aspiration.

    Science.gov (United States)

    Deniwar, Ahmed; Hammad, AbdulRahman Y; Ali, Daniah Bu; Alsaleh, Nuha; Lahlouh, Maha; Sholl, Andrew B; Moroz, Krzysztof; Aslam, Rizwan; Thethi, Tina; Kandil, Emad

    2017-02-01

    In the case of a nondiagnostic thyroid fine-needle aspiration (FNA) biopsy result, recent guidelines from the Bethesda system recommend repeat thyroid FNA after 3 months to prevent false-positive results. We aimed to examine our institutional data to determine whether the 3-month period affects the diagnostic yield of repeat biopsies. A retrospective review of patient records over a 5-year period at our institution was performed. Patients who required repeat FNA due to nondiagnostic results were included. The time between the FNA biopsies, adequacy of the FNA specimens, as well as the surgical pathology diagnosis were analyzed. We identified 317 patients who required a repeat FNA. Of these, 96 (30.3%) patients had repeat FNAs less than 3 months after initial biopsy, while 221 (69.7%) patients had repeat FNAs in greater than 3 months. One hundred five patients were referred to our clinic with an initial nondiagnostic biopsy from an outside institution. Repeat FNA was nondiagnostic in 35 patients (11.04%) in the total study population. There was no difference in satisfactory diagnostic yield between repeat FNAs performed greater than 3 months (201 patients, 90.95%) or less than 3 months (81 patients, 84.38%) after the initial biopsy (P = .117). Of the 35 patients with repeat nondiagnostic biopsy, 17 patients underwent diagnostic lobectomy and 3 (17.6%) patients were found to have malignant disease. Early (biopsy interval would alleviate stress on patients with benign nodules and expedite surgical intervention in patients with malignancy. Published by Elsevier Inc.

  18. Decrease in use of manual vacuum aspiration in postabortion care in Malawi: a cross-sectional study from three public hospitals, 2008-2012.

    Directory of Open Access Journals (Sweden)

    Maria L Odland

    Full Text Available OBJECTIVES: To investigate the use of manual vacuum aspiration in postabortion care in Malawi between 2008-2012. METHODS: A retrospective cross-sectional study was done at the referral hospital Queen Elisabeth Central Hospital, and the two district hospitals of Chiradzulu and Mangochi. The data were collected simultaneously at the three sites from Feb-March 2013. All records available for women admitted to the gynaecological ward from 2008-2012 were reviewed. Women who had undergone surgical uterine evacuation after incomplete abortion were included and the use of manual vacuum aspiration versus sharp curettage was analysed. RESULTS: Altogether, 5121 women were included. One third (34.2% of first trimester abortions were treated with manual vacuum aspiration, while all others were treated with sharp curettage. There were significant differences between the hospitals and between years. Overall there was an increase in the use of manual vacuum aspiration from 2008 (19.7% to 2009 (31.0%, with a rapid decline after 2010 (28.5% ending at only 4.9% in 2012. Conversely there was an increase in use of sharp curettage in all hospitals from 2010 to 2012. CONCLUSION: Use of manual vacuum aspiration as part of the postabortion care in Malawi is rather low, and decreased from 2010 to 2012, while the use of sharp curettage became more frequent. This is in contrast with current international guidelines.

  19. Salivary gland anlage tumor: cytologic features in a case examined by fine-needle aspiration.

    Science.gov (United States)

    Bondeson, L; Andreasson, L; Olsson, M; Rausing, A

    1997-06-01

    The cytologic features in fine-needle aspirates from a rare benign nasopharyngeal salivary gland anlage tumor in a newborn boy are described and commented on, regarding therapeutically important differential diagnoses.

  20. Aspiration-related organizing pneumonia complicating laparoscopic adjustable gastric banding: A lung cancer mimicker

    Directory of Open Access Journals (Sweden)

    Ahmed A Aljohaney

    2016-01-01

    Full Text Available There are several described pulmonary complications due to laparoscopic adjustable gastric banding. We report a rare case of a 32-year-old male who presented with pulmonary symptoms and a solitary lung mass 12 years after laparoscopic adjustable gastric banding. A bronchoscopic lung biopsy showed organizing pneumonia that was induced by aspiration pneumonia. The atypical radiological appearance of the aspiration pneumonia may pose a diagnostic challenge, and clinicians' awareness regarding such an entity is needed to avoid unnecessary intervention.

  1. Recurrent Aspiration Pneumonia due to Anterior Cervical Osteophyte

    Directory of Open Access Journals (Sweden)

    Jae Jun Lee

    2017-02-01

    Full Text Available A 74-year-old man presented with recurrent vomiting and aspiration pneumonia in the left lower lobe. He entered the intensive care unit to manage the pneumonia and septic shock. Although a percutaneous endoscopic gastrostomy tube was implanted for recurrent vomiting, vomiting and aspiration recurred frequently during admission. Subsequently, he complained of neck pain when in an upright position. A videofluoroscopic swallowing study showed compression of the esophagus by cervical osteophytes and tracheal aspiration caused by an abnormality at the laryngeal inlet. Cervical spine X-rays and computed tomography showed anterior cervical osteophytes at the C3-6 levels. Surgical decompression was scheduled, but was cancelled due to his frailty. Unfortunately, further recurrent vomiting and aspiration resulted in respiratory arrest leading to hypoxic brain damage and death. Physicians should consider cervical spine disease, such as diffuse skeletal hyperostosis as an uncommon cause of recurrent aspiration pneumonia.

  2. Diagnostic problems in fine needle aspiration cytology of fat necrosis within a subcutaneous lipoma

    OpenAIRE

    2008-01-01

    Fat necrosis in subcutaneous lipomas is very unusual and has been reported only occasionally. Literature regarding fine needle aspiration cytology of such a lesion is lacking although fat necrosis is well described in the breast. We came across a case of a large subcutaneous lipoma in the anterior abdominal wall with a well encapsulated area of fat necrosis. The aspiration smears showed an unusual picture which was misinterpreted as the fragments of the hydatid cyst wall. They were actually e...

  3. Severe Endobronchial Inflammation Induced by Aspiration of a Ferrous Sulfate Tablet

    Science.gov (United States)

    Lim, Sang Youn; Sohn, Sung Birm; Lee, Jung Min; Lee, Ji Ae; Chung, Sangmi; Kim, Junga; Choi, Juwhan; Kim, Sehwa; Yoo, Ah Young; Roh, Jong Ah; Park, Haein; Kim, Won Shik; Sim, Jae Kyeom; Shim, Jae Jeong

    2016-01-01

    Iron supplements such as ferrous sulfate tablets are usually used to treat iron-deficiency anemia in some elderly patients with primary neurologic disorders or decreased gag reflexes due to stroke, senile dementia, or parkinsonism. While the aspiration of ferrous sulfate is rarely reported, it is a potentially life-threatening condition that can lead to airway necrosis and bronchial stenosis. A detailed history and high suspicion of aspiration are required to avoid delays in diagnosis and treatment. The diagnosis can be confirmed by bronchoscopic examination and a tissue biopsy. Early removal of the aspirated tablet prevents acute complications, such as bronchial necrosis, hemoptysis, and lobar consolidation. Tablet removal is also necessary to prevent late bronchial stenosis. We presented the first case in Korea of a ferrous sulfate tablet aspiration that induced severe endobronchial inflammation. PMID:26770233

  4. A Feminist Reading of Sister Carrie: Carrie——the Aspiring Cinderella

    Institute of Scientific and Technical Information of China (English)

    殷娟

    2008-01-01

    Like Cinderella in the fairy tale Cinderella, Carrie is beautiful, innocent and poor. But unlike the traditional Cinderella who mindlessly waits around for a handsome prince to come to her rescue, Carrie, the aspiring Cinderella, resolvedly leaves the men she ever depended on and eventually becomes a successful actress. Sister Carrie, the most impressive heroine of Theodore Dreiser, is a contradictory character. Some accuse her of realizing her ambition with immoral means. However, some others take sympathy with her courage, determination, and aspiration. By analyzing the most distinguished quality of Sister Carrie - her aspiration, this essay is to illustrate from the perspective of feminism that women are not limited by their sex. Ignoring her own sex as well as the conventional attitude toward women in a male-dominated society, sister Carrie, full of aspiration, takes an active pan in creating and determining her own lives and her own futures..

  5. Fine Needle Aspiration Cytology: A Useful Technique for Diagnosis of Invasive Fungal Rhinosinusitis

    OpenAIRE

    2013-01-01

    Mycotic infections are on the rise globally. Patients with invasive fungal infection of the paranasal sinuses often present with destructive mass lesions and mimic malignancy clinically and radiologically. To assess the utility of Fine needle aspiration cytology for early diagnosis of invasive fungal rhinosinusitis. Fine needle aspiration cytology was performed from the maxillary/ethmoid sinus in patients with a destructive mass lesion in the maxilla. Differential diagnoses were malignancy an...

  6. Medical versus surgical abortion efficacy, complications and leave of absence compared in a partly randomized study

    DEFF Research Database (Denmark)

    Rørbye, Christina; Nørgaard, Mogens; Nilas, Lisbeth

    2004-01-01

    To provide optimal information to women choosing between early medical and surgical abortion, rigorous comparisons of the two methods are warranted. We compared the outcome of 1135 consecutive women with gestational age (GA) ... gemeprost) or a surgical abortion (vacuum aspiration in general anesthesia). One hundred eleven of these women were randomized for abortion method. Surgical interventions and complications leading to readmission within the following 15 weeks were identified through a computer system. Information about...... extra unscheduled consultation apart from a routine follow-up visit. We conclude that the chance of a primary successful termination at GA

  7. A comparison of two techniques of preparing bone marrow aspirate slides.

    Science.gov (United States)

    Aleem, Aamer; Alsaleh, Khalid; Aljabry, Mansour; Aziz, Shahid; Iqbal, Zafar; Almomen, Abdulkareem

    2016-05-01

    To compare direct smear technique with ethylenediaminetetraacetic acid (EDTA) preserved smear technique in terms of preparing bone marrow aspirate slides. This prospective study was carried out between September 2009 and July 2012 at the Haematology/Oncology Department, King Khalid University Hospital, Riyadh, Saudi Arabia. With a standard gauge disposable bone marrow aspirate needle, 0.5 to 1.0 ml bone marrow was aspirated with a 10ml syringe. Half of the marrow was immediately transferred to an EDTA tube with gentle mixing, while slides were prepared directly from the rest of the sample in the syringe. The tube sample was used to prepare slides at the end of the procedure. A score of 1-4 was assigned to each slide depending on the quality and number of particles. A total of 245 bone marrow aspirate samples were evaluated related to 216 patients. Of the total, 238 (97%) samples were included in the study. The mean score for the direct smear group was 3.40±0.79 and for the EDTA smear group it was 3.34±0.75 (p=0.27), which was not statistically significant. An informal comparison of the morphological analysis of the samples did not reveal any differences. Bone marrow aspirate slides prepared at the end of the procedure from EDTA preserved samples were not inferior to slides prepared directly from the aspirated sample.

  8. Comparison of a novel bedside portable endoscopy device with nasogastric aspiration for identifying upper gastrointestinal bleeding.

    Science.gov (United States)

    Choi, Jong Hwan; Choi, Jae Hyuk; Lee, Yoo Jin; Lee, Hyung Ki; Choi, Wang Yong; Kim, Eun Soo; Park, Kyung Sik; Cho, Kwang Bum; Jang, Byoung Kuk; Chung, Woo Jin; Hwang, Jae Seok

    2014-07-07

    To compare outcomes using the novel portable endoscopy with that of nasogastric (NG) aspiration in patients with gastrointestinal bleeding. Patients who underwent NG aspiration for the evaluation of upper gastrointestinal (UGI) bleeding were eligible for the study. After NG aspiration, we performed the portable endoscopy to identify bleeding evidence in the UGI tract. Then, all patients underwent conventional esophagogastroduodenoscopy as the gold-standard test. The sensitivity, specificity, and accuracy of the portable endoscopy for confirming UGI bleeding were compared with those of NG aspiration. In total, 129 patients who had GI bleeding signs or symptoms were included in the study (age 64.46 ± 13.79, 91 males). The UGI tract (esophagus, stomach, and duodenum) was the most common site of bleeding (81, 62.8%) and the cause of bleeding was not identified in 12 patients (9.3%). Specificity for identifying UGI bleeding was higher with the portable endoscopy than NG aspiration (85.4% vs 68.8%, P = 0.008) while accuracy was comparable. The accuracy of the portable endoscopy was significantly higher than that of NG in the subgroup analysis of patients with esophageal bleeding (88.2% vs 75%, P = 0.004). Food material could be detected more readily by the portable endoscopy than NG tube aspiration (20.9% vs 9.3%, P = 0.014). No serious adverse effect was observed during the portable endoscopy. The portable endoscopy was not superior to NG aspiration for confirming UGI bleeding site. However, this novel portable endoscopy device might provide a benefit over NG aspiration in patients with esophageal bleeding.

  9. Minority Ethnic Students and Science Participation: a Qualitative Mapping of Achievement, Aspiration, Interest and Capital

    Science.gov (United States)

    Wong, Billy

    2016-02-01

    In the UK, the `leaky pipeline' metaphor has been used to describe the relationship between ethnicity and science participation. Fewer minority ethnic students continue with science in post-compulsory education, and little is known about the ways in which they participate and identify with science, particularly in the secondary school context. Drawing on an exploratory study of 46 interviews and 22 h of classroom observations with British students (aged 11-14) from Black Caribbean, Bangladeshi, Pakistani, Indian and Chinese ethnic backgrounds, this paper identified five `types' of science participation among minority ethnic students. The five types of science participation emerged from an analysis of students' science achievement, science aspiration, science interest and science capital. The characteristics of the five types are as follows: Science adverse students have no aspirations towards science and lacked interest, achievement and capital in science. Science intrinsic students have high science aspirations, interest and capital but low science attainment. Students who are science intermediate have some aspirations, interest and capital in science, with average science grades. Science extrinsic students achieve highly in science, have some science capital but lacked science aspirations and/or interest. Science prominent students are high science achievers with science aspirations, high levels of interest and capital in science. The findings highlight that minority ethnic students participate in science in diverse ways. Policy implications are suggested for each type as this paper provides empirical evidence to counter against public (and even some academic) discourses of minority ethnic students as a homogeneous group.

  10. University of Pennsylvania aspiration cart (Penn-A-Cart): an innovative journey in fine needle aspiration service.

    Science.gov (United States)

    Gupta, Prabodh K

    2010-01-01

    On-site evaluation of fine needle aspiration specimens is now considered the standard of care. The procedure is performed at the bedside and at various other locations within the hospital using a mobile cart fitted with essentials, including a microscope, stains and supplies. Earlier, an open specimen cart was used with various supplies and a binocular microscope. The mobile cart during the past 25 years has been variously modified. A second-generation cart containing 2 folding pods, a double-headed microscope, supplies and stains had been used for the past 20 years; it did not meet the current regulatory standards and needs, and little attention was paid to meet the Joint Commission on the Accreditation of Healthcare Organizations, Health Insurance Portability and Accountability Act and infection control standards. Also, the repeated lifting of the microscope resulted in much wear and tear. We have designed Penn-A-Cart, which has a pneumatic lift for the microscope, a high-definition camera with a TV screen and access to the Internet. It has a sharps container and storage space for supplies, stains and slides. This cart meets the various regulatory agency standards. It is user friendly and valuable for multiviewing. The cart is valuable for remote access, telecytopathology and improved patient care.

  11. Fine-needle aspiration cytology of ameloblastoma and malignant ameloblastoma: a study of 12 cases.

    Science.gov (United States)

    Klapsinou, Eirini; Stavros, Archondakis; Smaragda, Angeli; Despoina, Proestou; Dimitra, Daskalopoulou

    2013-03-01

    Ameloblastoma is an odontogenic tumor with aggressive biological behavior, high recurrence rate, and a complex microscopic appearance with many different histologic patterns. Primary ameloblastoma is also described in extragnathic locations. Because of its wide morphologic spectrum, which is mirrored also in cytologic smears, a thorough study of distinctive features is required to reach a reliable diagnosis. Twelve cases of ameloblastoma were examined both cytologically and histologically. The patients were seven women and five men 24-85 years old, mean age being 64 years. Eleven cases were primary tumors of the mandible and maxilla, and one case was a lung tumor metastatic from the tibia. The epithelial element in the cytologic smears of the various cases was morphologically diverse. The basaloid pattern and minimal nuclear atypia were rather constant findings, and the most helpful features toward reaching a cytological diagnosis. However in most cases, careful consideration of the clinical, radiological, cytological, and occasionally immunocytochemical data was required to rule out other entities with similar cytological findings. In some cases, the final diagnosis was only possible by histologic examination. Due to their variable microscopic morphology, ameloblastomas are quite often misdiagnosed for other entities, both benign and malignant. Nevertheless, when one is aware of their distinctive features, an accurate diagnosis can be made by fine-needle aspiration cytology, in conjunction with clinical and radiological findings. Both the preoperative surgical planning and the postoperative follow-up of the patients benefit significantly from this method. Copyright © 2011 Wiley Periodicals, Inc.

  12. A novel technique to release sticking haptic of a single-piece hydrophobic acrylic IOL using irrigation-aspiration probe.

    Science.gov (United States)

    Khokhar, Sudarshan Kumar; Midha, Neha; Patil, Bharat; Nayak, Bhagabat; Simakurthy, Sriram

    2016-01-01

    To describe a novel technique to release sticking haptic of a single-piece hydrophobic acrylic intraocular lens (IOL) using irrigation-aspiration (I/A) probe. In our technique, the I/A probe is introduced into the anterior chamber on Visco mode. Using the aspiration port of the I/A probe, the sticking haptic is held at its tip and suction force is built up until occlusion is noted. Then the haptic is nudged towards the center of the IOL along its curve. After the haptic is free from optic, the suction is released. Several techniques have been described to release the sticking haptic such as squeezing the haptic at the site where it sticks to the IOL or using Sinskey hook for releasing the adhesion. These techniques require extra manipulation of the IOL by introduction of surgical instruments. In our technique, we used the I/A probe itself for separating the sticky haptic successfully. This technique allows separation of sticking haptic without any extra instrumentation, thus reducing intraocular maneuvering and total surgery time.

  13. Poverty and Aspirations Failure

    NARCIS (Netherlands)

    Dalton, P.S.; Ghosal, S.; Mani, A.

    2011-01-01

    We develop a theoretical framework to study the psychology of poverty and 'aspirations failure'. In our framework, the rich and the poor share the same preferences - and also a behavioral bias in setting aspirations. Greater downside risks imposed by poverty exacerbates the effects of this behaviora

  14. Aspiration and leadership

    NARCIS (Netherlands)

    Jagersma, P.K.

    2007-01-01

    Management needs an aspiration as to how the company will work in the future. It needs a guide for corporate priorities. Any company - local or global - must be driven by an aspiration that energizes and motivates the company from top to bottom. Yet very few managers and executives know how a corpor

  15. Aspiration in Jaffna Tamil

    Science.gov (United States)

    Thananjayarajasingham, S.

    1975-01-01

    The article accounts for the phenomenon of aspiration in Jaffna Tamil, a dialect distinct form South Indian dialects of Tamil. Not being distinctive orphonologically determined, aspiration is dealt with as a prosodic feature affecting voiceless stops in various positions. Distribution and symbolic representation are handled; kymographic evidence…

  16. Poverty and Aspirations Failure

    NARCIS (Netherlands)

    Dalton, P.S.; Ghosal, S.; Mani, A.

    2011-01-01

    We develop a theoretical framework to study the psychology of poverty and 'aspirations failure'. In our framework, the rich and the poor share the same preferences - and also a behavioral bias in setting aspirations. Greater downside risks imposed by poverty exacerbates the effects of this behaviora

  17. Diagnostic Value of Processing Cytologic Aspirates of Renal Tumors in Agar Cell (Tissue) Blocks

    DEFF Research Database (Denmark)

    Smedts, F.; Schrik, M.; Horn, T.;

    2010-01-01

    Objective To adapt a method enabling utilization of most of the harvest from a fine needle aspirate in an effort to improve diagnostic accuracy in the assessment of a renal tumor in a single histologic slide. Study Design In a series of 43 renal tumors, 2 fine needle aspirations were performed, 4...... smears were prepared after each aspiration for conventional cytology and the remaining aspirate was processed for the improved agar microbiopsy (AM) method. Conventional cytology slides, AM slides and surgical specimens were diagnosed separately, after which the diagnoses were compared...

  18. Aspirations of Rural Youth.

    Science.gov (United States)

    Bajema, Duane H.; Miller, W. Wade; Williams, David L.

    2002-01-01

    Of 883 Iowa high school seniors, 60% lived in towns, 40% on farms. Both groups had a high level of congruence between educational and occupational aspirations and perceived minimal barriers to goal achievement. Farm and town students had equally diverse aspirations. (Contains 23 references.) (SK)

  19. Ultrasound-guided Transvaginal Aspiration in the Management of Actinomyces Pelvic Abscess

    OpenAIRE

    1996-01-01

    Background: Increasing reports of intrauterine device (IUD)-related abdominopelvic actinomycosis have been described recently. Surgical therapy has been the usual treatment when tubo-ovarian abscess is identified. Case: A 38-year-old woman suffering from Actinomyces pelvic abscess unresponsive to medical treatment underwent transvaginal ultrasound-guided needle aspiration. It resulted in marked improvement and avoided surgical treatment. Conclusion: Transvaginal needle aspiration of Actinomyc...

  20. Small intestine aspirate and culture

    Science.gov (United States)

    ... ency/article/003731.htm Small intestine aspirate and culture To use the sharing features on this page, please enable JavaScript. Small intestine aspirate and culture is a lab test to check for infection ...

  1. Identification of microfilaria in a mammary mass aspirate from a female dog

    Science.gov (United States)

    Burgess, Hilary J.; Wagner, Brent

    2016-01-01

    A filarial nematode larva (microfilaria) was found in an aspirate of a mammary mass from a dog imported to Saskatchewan from Myanmar. This was an unusual location for a microfilaria and numerous filarial nematodes infecting dogs in Asia had to be considered. This report describes the laboratory diagnosis of canine heartworm disease in this dog. PMID:27041753

  2. Aspirated Compressors for High Altitude Engines Project

    Data.gov (United States)

    National Aeronautics and Space Administration — Aurora Flight Sciences proposes to incorporate aspirated compressor technology into a high altitude, long endurance (HALE) concept engine. Aspiration has been proven...

  3. A radial basis classifier for the automatic detection of aspiration in children with dysphagia

    Directory of Open Access Journals (Sweden)

    Blain Stefanie

    2006-07-01

    Full Text Available Abstract Background Silent aspiration or the inhalation of foodstuffs without overt physiological signs presents a serious health issue for children with dysphagia. To date, there are no reliable means of detecting aspiration in the home or community. An assistive technology that performs in these environments could inform caregivers of adverse events and potentially reduce the morbidity and anxiety of the feeding experience for the child and caregiver, respectively. This paper proposes a classifier for automatic classification of aspiration and swallow vibration signals non-invasively recorded on the neck of children with dysphagia. Methods Vibration signals associated with safe swallows and aspirations, both identified via videofluoroscopy, were collected from over 100 children with neurologically-based dysphagia using a single-axis accelerometer. Five potentially discriminatory mathematical features were extracted from the accelerometry signals. All possible combinations of the five features were investigated in the design of radial basis function classifiers. Performance of different classifiers was compared and the best feature sets were identified. Results Optimal feature combinations for two, three and four features resulted in statistically comparable adjusted accuracies with a radial basis classifier. In particular, the feature pairing of dispersion ratio and normality achieved an adjusted accuracy of 79.8 ± 7.3%, a sensitivity of 79.4 ± 11.7% and specificity of 80.3 ± 12.8% for aspiration detection. Addition of a third feature, namely energy, increased adjusted accuracy to 81.3 ± 8.5% but the change was not statistically significant. A closer look at normality and dispersion ratio features suggest leptokurticity and the frequency and magnitude of atypical values as distinguishing characteristics between swallows and aspirations. The achieved accuracies are 30% higher than those reported for bedside cervical auscultation. Conclusion

  4. Comparison of bronchoalveolar lavage fluid obtained by manual aspiration with a handheld syringe with that obtained by automated suction pump aspiration from healthy dogs.

    Science.gov (United States)

    Woods, Katharine S; Defarges, Alice M N; Abrams-Ogg, Anthony C G; Dobson, Howard; Brisson, Brigitte A; Viel, Laurent; Bienzle, Dorothee

    2014-01-01

    To compare bronchoalveolar lavage (BAL) fluid obtained by manual aspiration (MA) with a handheld syringe with that obtained by suction pump aspiration (SPA) in healthy dogs. 13 adult Beagles. Each dog was anesthetized and bronchoscopic BAL was performed. The MA technique was accomplished with a 35-mL syringe attached to the bronchoscope biopsy channel. The SPA technique was achieved with negative pressure (5 kPa) applied to the bronchoscope suction valve with a disposable suction trap. Both aspiration techniques were performed in each dog in randomized order on opposite caudal lung lobes. Two 1 mL/kg aliquots of warm saline (0.9% NaCl) solution were infused per site. For each BAL fluid sample, the percentage of retrieved fluid was calculated, the total nucleated cell count (TNCC) and differential cell count were determined, and semiquantitative assessment of slide quality was performed. Comparisons were made between MA and SPA techniques for each outcome. 1 dog was removed from the study because of illness. The mean percentage of fluid retrieved (mean difference, 23%) and median TNCC (median distribution of differences, 100 cells/μL) for samples obtained by SPA were significantly greater than those for samples obtained by MA. In healthy dogs, BAL by SPA resulted in a significantly higher percentage of fluid retrieval and samples with a higher TNCC than did MA. Further evaluation of aspiration techniques in dogs with respiratory tract disease is required to assess whether SPA improves the diagnostic yield of BAL samples.

  5. Aspire UWA: A case study of widening access in Higher Education

    Directory of Open Access Journals (Sweden)

    Judy Skene

    2016-07-01

    Full Text Available Widening university access to students from low socio-economic status (LSES and non-traditional backgrounds has been a key equity objective for Australian universities, particularly since the 2008 Review into Australian Higher Education (Bradley, Noonan, Nugent & Scales, 2008. Aspire UWA is an equity pathway that aims to inform aspirations and build academic attainment through direct involvement with students who are the “most able least likely” to access the benefits of higher education (Harris, 2010, p. 7. Through forming long-term partnerships with 63 secondary schools across Western Australia (WA, Aspire UWA has grown since 2009 to engage over 10,000 students annually. Its learning framework is designed to deliver age-appropriate activities to inspire and inform students from Years 7-12 to achieve their educational goals. This paper adopts a case study methodology to explore the Aspire UWA approach, the specific operation of Aspire UWA and the efficacy of the program. 

  6. A novel pneumatic micropipette aspiration method using a balance pressure model.

    Science.gov (United States)

    Zhao, Qili; Wu, Ming; Cui, Maosheng; Qin, Yanding; Yu, Jin; Sun, Mingzhu; Zhao, Xin; Feng, Xizeng

    2013-12-01

    This paper presents a novel micropipette aspiration (MA) method based on a common pneumatic micro-injection system. This method is the first to quantify the influence of capillary effect on aspiration pressure using a balance pressure model, and in return, uses the capillary effect to quantify the aspiration pressure. Subsequently, the seal between the cell and the micropipette is detected to judge and exclude the ineffective MA attempts. The rationality of the balance pressure model is validated by the designed micropipette-filling experiments. Through applied to elasticity-determination of the cells with different sizes, the feasibility and versatility of this MA method are proved. With abilities to quantify aspiration pressures and detect the seam between the cell and the micropipette, our method is expected to advance the application of the commercial pneumatic injector in the MA of cells. Moreover, with the quantified volume of the liquid entering into the micropipette during MA process, our method also has a potential applicability to the study of the permeability of the cell membrane in the future.

  7. A novel pneumatic micropipette aspiration method using a balance pressure model

    Science.gov (United States)

    Zhao, Qili; Wu, Ming; Cui, Maosheng; Qin, Yanding; Yu, Jin; Sun, Mingzhu; Zhao, Xin; Feng, Xizeng

    2013-12-01

    This paper presents a novel micropipette aspiration (MA) method based on a common pneumatic micro-injection system. This method is the first to quantify the influence of capillary effect on aspiration pressure using a balance pressure model, and in return, uses the capillary effect to quantify the aspiration pressure. Subsequently, the seal between the cell and the micropipette is detected to judge and exclude the ineffective MA attempts. The rationality of the balance pressure model is validated by the designed micropipette-filling experiments. Through applied to elasticity-determination of the cells with different sizes, the feasibility and versatility of this MA method are proved. With abilities to quantify aspiration pressures and detect the seam between the cell and the micropipette, our method is expected to advance the application of the commercial pneumatic injector in the MA of cells. Moreover, with the quantified volume of the liquid entering into the micropipette during MA process, our method also has a potential applicability to the study of the permeability of the cell membrane in the future.

  8. Repeated cyst formation in a patient with leukoencephalopathy, cerebral calcifications, and cysts: effectiveness of stereotactic aspiration with Ommaya reservoir placement.

    Science.gov (United States)

    Ooba, Hiroshi; Abe, Tatsuya; Hisamitsu, Yoshinori; Fujiki, Minoru

    2013-08-01

    The combination of leukoencephalopathy, cerebral calcifications, and cysts (LCC) constitutes a rare cerebral disorder characterized by distinctive neuroradiological and clinical findings. Twenty-eight cases of LCC have been reported. Surgery is usually required to treat progressively expanding cysts, but surgical strategies have been varied. The authors present the case of a patient who underwent 4 surgical procedures for repeated cyst formation. The first operation was performed for the removal of a cyst and to make a histopathological diagnosis. The second and third operations were performed to treat de novo cysts. The fourth operation was performed to treat a recurrence. This is the first reported case of LCC in which it was necessary to perform surgery 4 times, in large part due to de novo cyst formation. It provides evidence that multiple cysts may develop in these patients and that several surgical operations may be needed to treat LCC. Stereotactic aspiration with Ommaya reservoir placement is an appropriate procedure for this condition because it is less invasive and more repeatable than open surgery.

  9. Fine-needle aspiration cytology of mammary fibroadenoma: a comparison of ThinPrep® and cytospin preparations.

    Science.gov (United States)

    Ly, Thai Yen; Barnes, Penny J; Macintosh, Rebecca F

    2011-03-01

    Mammary fibroadenoma (FA) is a lesion frequently sampled and diagnosed by fine-needle aspiration (FNA). Accurate cytologic diagnosis of this common benign lesion is important as this can lead to non-surgical, conservative management when breast imaging and clinical examination are concordant. In most instances, a confident diagnosis of FA is possible because of a characteristic cytologic appearance that includes hypercellularity, large epithelial cell groups, staghorn epithelial configurations, stromal fragments, and numerous background stripped nuclei. Nevertheless, FAs can be diagnostically challenging because of shared cytomorphologic features with other benign lesions and low-grade carcinoma. As such, FA is a well-recognized source of false results on FNA cytology. Furthermore, there are reports that newer thin layer cytopreparatory techniques, including the ThinPrep® (TP) system (Hologic Corp., Bedford, MA), alter the appearance of FA on FNA compared to conventional preparations and may compromise accurate cytologic diagnosis. Copyright © 2010 Wiley-Liss, Inc.

  10. LYMPH NODE ASPIRATION CYTOLOGY FINDING IN HIV INFECTED CASES OF A RURAL POPULATION IN SOUTH INDIA

    Directory of Open Access Journals (Sweden)

    Amrutha

    2015-10-01

    Full Text Available OBJECTIVE: To evaluate the findings of aspiration cytology of lymph nodes in HIV infected subjects in a rural population. STUDY DESIGN: The study was conducted in rural population of field practice area of Kamineni institute of medical sciences ( KIMS, Narketpally, Nalgonda. Fine needle aspiration ( FNA was done from different lymph - node site from 50 HIV infected subjects, both air dried and wet smears were prepared. Routine cytology stains and when required special stain were done. Detailed cytomorphological study was conducted. RESULTS: Tuberculus lymphadenitis 28(56% was most common finding followed by reactive lymphadenitis 14(28%, G ranulomatous lymphadenitis 6(12% and suppurative lymphadenitis 2(4%. No other opportunistic infection or malignancy was seen in our study. CONCLUSION: Tuberculus lymphadenitis is the most common cause of lymphadenopathy in HIV infected individuals follow ed by reactive lympadenitis. Fine needle aspiration cytology ( FNAC is a very useful tool in early diagnosis of opportunistic infection and in providing appropriate treatment .

  11. Crown lengthening: a surgical flap approach.

    Science.gov (United States)

    Lundergan, W; Hughes, W R

    1996-09-01

    In many instances it is not possible to place a restoration margin without encroaching on the periodontal attachment apparatus. A surgical crown-lengthening procedure can provide a good solution to this common clinical problem. This article discusses indication and contraindication for surgical crown-lengthening procedures and presents an appropriate surgical technique.

  12. A New Surgical Technique for Ingrown Toenail

    OpenAIRE

    Seyed Reza Mousavi; Jaledin Khoshnevice

    2012-01-01

    Background. Ingrowing toenails are a common condition which, when recurrent and painful, are often treated surgically. The aim of this study is to present a new simple surgical technique for ingrown toenails with good results. Method and Patients. The selected 250 patients with affected toes were surgically treated by our technique and observed from 1998 to 2004. Marginal nail elevation combined with surgical excision of the granulation tissue was more successful. For fixing the nail margin o...

  13. Subcutaneous metastases of sarcomatoid mesothelioma with its differential diagnosis on fine needle aspiration--a case report.

    Science.gov (United States)

    Patel, Trupti; Bansal, Rimpi; Trivedi, Priti; Modi, Lopa; Shah, M J

    2005-10-01

    Metastasis of mesothelioma of the pleura, to the skin and subcutis is an extremely rare occurrence. A 25 year old woman, who had undergone chemotherapy, partial excision of tumor followed by radiotherapy of sarcomatoid mesothelioma of the pleura, presented three months later with painless widespread subcutaneous nodules. FNAC of these nodules reveled pleomorphic malignant spindle shaped cell with epithelioid morphology. The subcutis is a particularly rare site of metastatic sarcomatoid mesothelioma. It is essential to differentiate neoplasm metastatic to the skin and subcutis from primary and benign lesions of the same region. FNAC is accurate and efficient, in conjugation with clinical history, and it also prevents surgical biopsy in the diagnosis of metastatic subcutaneous lesion. To our knowledge, this is the first case, reported till date, in which the sarcomatoid mesothelioma metastasized to the subcutaneous tissue and was diagnosed by fine needle aspiration cytology (FNAC).

  14. Surgical electronic logbook: A step forward.

    Science.gov (United States)

    Gómez Díaz, Carlos Javier; Luna Aufroy, Alexis; Rebasa Cladera, Pere; Serra Pla, Sheila; Jurado Ruiz, Cristina; Mora López, Laura; Serra Aracil, Xavier; Navarro Soto, Salvador

    2015-12-01

    The surgical electronic logbook (surgical e-logbook) aims to: simplify registration of the training activities of surgical residents, and to obtain reliable and detailed reports about these activities for resident evaluation. The surgical e-logbook is a unique and shared database. Residents prospectively record their activities in 3 areas: surgical, scientific and teaching. We can access activity reports that are constantly updated. Study period using the surgical e-logbook: Between June 2011 and May 2013. Number of surgeries reported: 4,255. Number of surgical procedures reported: 11,907. Number of surgeries per resident per year reported: 250. Number of surgical procedures per resident per year reported: 700. Surgical activity as a primary surgeon during the first year of residency is primarily in emergency surgery (68,01%) and by laparotomy (97,73%), while during the fifth year of residency 51,27% is performed in elective surgery and laparoscopy is used in 23,10% of cases. During this period, residents participated in a total of 11 scientific publications, 75 conference presentations and 69 continuing education activities. The surgical e-logbook is a useful tool that simplifies the recording and analysis of data about surgical and scientific activities of the residents. It is a step forward in the evaluation of the training of surgical residents, however, is only an intermediate step towards the development of a larger Spanish registry. Copyright © 2014 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.

  15. A Rare Cause of Dyspnea in Elderly Patients: Foreign Body Aspiration

    Directory of Open Access Journals (Sweden)

    Sevdegül Karadas

    2012-10-01

    Full Text Available Foreign body aspiration is frequently seen at childhood age group whereas various facilitator factors can be observed in adults particularly in the elderly group. In this study a 78 year-old male case who swallowed his dental prothesis and had a foreign substance detected in his chest X-ray was presented. In the cases that have nonspesific complaints such as incipient chest pain and difficulty in breathing and have no known underlying lung disease, foreign body aspiration must be suspected.

  16. A Comparison Study of Oral RU486/Cytotec and Vacuum Aspiration for Termination of Early Preganacy

    Institute of Scientific and Technical Information of China (English)

    杜明昆; 应玉娣; 郑怀美; 闻珍; 倪如珏

    1996-01-01

    Objective : This study is to compare the personal acceptability and effect of Oral RU486/PG versus surgical vacuum aspiration on termination of early pregnancy. Method: Subjects were recruited by their voluntary choice of methods. One hundred women aged 20~34 with amenorrhea of 35~42 days chose the medical method (RU486 600 mg on the lst day and cytotec 0. 4 mg on the 3rd day). One hundred women aged 20~34 with amenorrbea < 56 days chose vacuum aspiration. Subjects were asked to return on the 17th day in the medical group and 14th day in the surgical group for follow-up. Results: Complete abortion rates in the medical and surgical groups were 89% and 100% respectively. The main reason for choosing medicalabortion was "less painful" (94%) while that for choosing surgical abortion was "quick and saving time (55 % ), with removing or insering IUD (45 % ) following surgical abortion", Conclusion : For pregnancy termination RU486/Cytotec (PGE1) and vacuum aspiration are both highly acceptable, Each method has its own advantages and disadvantages and they can not replace each other. Selective use can provide advantages of either method. The earlier the termination, the safer the event.

  17. Characterization of the innate immune response to chronic aspiration in a novel rodent model

    Directory of Open Access Journals (Sweden)

    Lin Shu S

    2007-11-01

    Full Text Available Abstract Background Although chronic aspiration has been associated with several pulmonary diseases, the inflammatory response has not been characterized. A novel rodent model of chronic aspiration was therefore developed in order to investigate the resulting innate immune response in the lung. Methods Gastric fluid or normal saline was instilled into the left lung of rats (n = 48 weekly for 4, 8, 12, or 16 weeks (n = 6 each group. Thereafter, bronchoalveolar lavage specimens were collected and cellular phenotypes and cytokine concentrations of IL-1alpha, IL-1beta, IL-2, IL-4, IL-6, IL-10, GM-CSF, IFN-gamma, TNF-alpha, and TGF-beta were determined. Results Following the administration of gastric fluid but not normal saline, histologic specimens exhibited prominent evidence of giant cells, fibrosis, lymphocytic bronchiolitis, and obliterative bronchiolitis. Bronchoalveolar lavage specimens from the left (treated lungs exhibited consistently higher macrophages and T cells with an increased CD4:CD8 T cell ratio after treatment with gastric fluid compared to normal saline. The concentrations of IL-1alpha, IL-1beta, IL-2, TNF-alpha and TGF-beta were increased in bronchoalveolar lavage specimens following gastric fluid aspiration compared to normal saline. Conclusion This represents the first description of the pulmonary inflammatory response that results from chronic aspiration. Repetitive aspiration events can initiate an inflammatory response consisting of macrophages and T cells that is associated with increased TGF-beta, TNF-alpha, IL-1alpha, IL-1beta, IL-2 and fibrosis in the lung. Combined with the observation of gastric fluid-induced lymphocyitic bronchiolitis and obliterative bronchiolitis, these findings further support an association between chronic aspiration and pulmonary diseases, such as obliterative bronchiolitis, pulmonary fibrosis, and asthma.

  18. What Is a "Good" Principal? Perspectives of Aspiring Principals in Singapore

    Science.gov (United States)

    Ng, Pak Tee

    2016-01-01

    This paper presents the findings of an exploratory research project that examines what aspiring principals in Singapore think a good principal is, based on a framework of personal, interpersonal, and organizational dimensions of school leadership. According to the findings, a good principal has a moral purpose centered on personal values, a humble…

  19. Microbial profile of the vitreous aspirates in culture proven exogenous endophthalmitis: A 10-year retrospective study

    Directory of Open Access Journals (Sweden)

    H Bhattacharjee

    2016-01-01

    Full Text Available Purpose: To describe the microbiological profile and clinical outcome in the eyes with culture-proven exogenous endophthalmitis. Methods: A retrospective analysis of 495 eyes diagnosed as exogenous endophthalmitis was performed over a period of 10 years. In all, aseptically collected aqueous and vitreous aspirates were cultured for bacteria and fungus using standard microbiological techniques. Gram-stain and KOH preparation of the specimens were also performed. The antibiotic susceptibility testing for bacterial isolates was performed by Kirby-Bauer disk diffusion method. The treatment was modified according to the antibiotic sensitivity profile. The final clinical ocular condition was divided into improved, stable or deteriorated. Results: Of 148 culture-proven endophthalmitis eyes, 137 (92.57% were referred from elsewhere, and 11 (7.43% belonged to our institute. Aetiologically, 76 (51.35% eyes were post-cataract surgery, 61 (41.22% were post-traumatic, 5 (3.38% eyes post-intravitreal anti-vascular endothelial growth factor injection, 5 associated with corneal diseases and 1 bleb-related endophthalmitis. In 31 (20.95% eyes, primary intravitreal antibiotics were given outside. The cultures revealed monomicrobial growth in 92.57% (n = 137 and polymicrobial growth in 7.43% (n = 11. Among the bacteria (n = 121, 81.76%, Pseudomonas species dominated overall (n = 32, 27.11% and post-operative (n = 26, 38.23% endophthalmitis group. Staphylococcus epidermidis (n = 14, 28% was prominent in post-traumatic endophthalmitis group. Ninety-two percent (n = 108 isolates of bacteria were sensitive to vancomycin. In 78 (52.7% eyes, the clinical ocular condition improved or remained stable while deteriorated in 51 (34.46%. Conclusion: A bacterial predominance was observed among causative organisms of exogenous endophthalmitis with Pseudomonas species being the most common. The appropriate surgical intervention improved or stabilised the visual acuity in nearly

  20. Barium aspiration and alveolarisation of barium in an infant: A case report and review of management

    Directory of Open Access Journals (Sweden)

    Alan F. Isles

    2014-05-01

    Full Text Available We describe a case of bilateral inhalation and alveolarisation of barium in an infant following a barium swallow for investigation of dusky spells associated with feeds. A bronchoscopy subsequently revealed the presence of a mid-tracheal tracheo-oesophageal cleft. We review the literature on barium aspiration, its consequences and make recommendations for management.

  1. FINE NEEDLE ASPIRATION CYTOLOGY IS A DIAGNOSTIC TOOL IN THE THYROID LESION

    Directory of Open Access Journals (Sweden)

    Mani

    2015-12-01

    Full Text Available Thyroid nodules the main indication for FNAC, and the goal of this diagnostic procedure is to detect thyroid neoplasm for surgical resection and to identify non-neoplastic lesions that may be managed conservatively. MATERIAL AND METHOD Three hundred and fourteen patients with thyroid nodules diagnosed on physical examination underwent fine-needle aspiration with 23-gauge needle and 10ml syringe. FNAC results were classified into non-neoplastic lesion and neoplastic lesion for diagnosis. RESULT AND ANALYSIS We included 314 cases; 37 were male and 277 were female with female-to-male ratio of 7.48:1. The age ranged from 8 to 87 years with a median age of 47.5 years. Maximum number of patients were found in age group of 41-50 years. In the present study we found 285(90.76% non-neoplastic lesion and 29(9.23% neoplastic lesions. Out of 285 non-neoplastic lesion, most commonly encountered were colloid goiter 178(56.68% and second most common thyroiditis 100(31.84%. Out of 314,29(9.23% neoplastic lesions, most commonly encountered neoplasm were papillary carcinoma 14(4.45% followed by 9(2.86% follicular neoplasm, Hurthle cell neoplasm 2(0.63%, medullary carcinoma 4(1.27%. AIMS AND OBJECTIVES  To study the distribution of various thyroid lesions among the age and sex groups.  To study the cytomorphological, clinical and biochemical correlation. CONCLUSION Clinical features and serum findings when used alone to diagnose thyroid lesion, diagnosis will be missed in many cases.

  2. Pulmonary aspiration in hospitalized adults.

    Science.gov (United States)

    Elpern, E H

    1997-02-01

    Until recent years, pulmonary aspiration attracted remarkably little clinical investigation. Although aspiration was considered a common occurrence in hospitalized individuals, with serious and even fatal consequences, clinicians had limited scientific data to guide practice. Consequently, approaches to this problem were based largely on unsystematic observations, intuition, and tradition. Recent investigations on the subjects of aspiration have increased our understanding of patients at risk for aspiration, the value of diagnostic methods, and the efficacy of interventions to prevent or limit aspirations. Results of these studies call to question many time-honored adages and practices. Considerable uncertainty remains and more investigation is necessary before management decisions can be characterized clearly and clinical strategies defined. This review focuses on pulmonary aspiration and enteral feeding in the critically ill adult. Factors implicated in aspiration in this population are highlighted and evidence to support the application of interventions prescribed commonly is presented.

  3. A personal letter to an aspiring physician or nurse (or other caring professional).

    Science.gov (United States)

    Savett, Laurence A

    2014-01-01

    In a letter to an aspiring physician or nurse, the author describes some of the important dimensions and timeless values of a fulfilling career in health care, the importance of the professional-patient relationship, ways to make an informed career choice, the guidance provided by sound values, and his response to some of the myths about health care careers.

  4. Malthematical Preparation versus Career Aspirations: A Study of Wyoming's 1978 High School Seniors.

    Science.gov (United States)

    Kansky, Bob; Olson, Melfried

    This report provides a general description of the mathematical programs pursued by students in Wyoming's public schools, an evaluation of the adequacy of the high school mathematical preparation of college-bound students relative to the occupational aspirations of those students, and a measure of the extent to which students are aware of the…

  5. Academic performance, educational aspiration and birth outcomes among adolescent mothers: a national longitudinal study.

    Science.gov (United States)

    Xie, Yiqiong; Harville, Emily Wheeler; Madkour, Aubrey Spriggs

    2014-01-15

    Maternal educational attainment has been associated with birth outcomes among adult mothers. However, limited research explores whether academic performance and educational aspiration influence birth outcomes among adolescent mothers. Data from Waves I and IV of the National Longitudinal Study of Adolescent Health (Add Health) were used. Adolescent girls whose first pregnancy occurred after Wave I, during their adolescence, and ended with a singleton live birth were included. Adolescents' grade point average (GPA), experience of ever skipping a grade and ever repeating a grade, and their aspiration to attend college were examined as predictors of birth outcomes (birthweight and gestational age; n = 763). Univariate statistics, bivariate analyses and multivariable models were run stratified on race using survey procedures. Among Black adolescents, those who ever skipped a grade had higher offspring's birthweight. Among non-Black adolescents, ever skipping a grade and higher educational aspiration were associated with higher offspring's birthweight; ever skipping a grade was also associated with higher gestational age. GPA was not statistically significantly associated with either birth outcome. The addition of smoking during pregnancy and prenatal care visit into the multivariable models did not change these associations. Some indicators of higher academic performance and aspiration are associated with better birth outcomes among adolescents. Investing in improving educational opportunities may improve birth outcomes among teenage mothers.

  6. Effect of Partial Span Aspiration on the Performance of a Transonic Axial Compressor Rotor: A Numerical Study

    Directory of Open Access Journals (Sweden)

    Vijaykumar Jain

    2015-01-01

    Full Text Available Aspiration in an axial compressor is normally regarded as sucking out the low momentum boundary layer from blade suction surface, thus lowering the chances of flow separation and consequently that of stall under off-design operation. However, the suction mass flow does not take part in useful work and leads to loss of engine power output. This paper deals with a new concept of natural aspiration to energize blade suction surface boundary layer by injecting some fluid from pressure to suction side through a part span slot on the blade. The energized boundary layer has lesser tendency to separate, thus enhancing stall margin. Numerical simulations were carried out to study the effect of aspiration slot location and geometry on the performance and stall margin of a transonic axial compressor rotor. The computational results without aspiration slot were in fair agreement with the published experimental data. The modified rotor, with part span aspiration, showed ~3.2% improvement in stall margin at design rotational speed. The pressure ratio and efficiency of the aspirated rotor dropped by ~1.42% and ~2.0%, respectively, whereas the structural analysis did not indicate any adverse effect on the blade stress distribution in the presence of aspiration slot.

  7. Directionality of the Associations of High School Expectancy-Value, Aspirations, and Attainment: A Longitudinal Study

    Science.gov (United States)

    Guo, Jiesi; Marsh, Herbert W.; Morin, Alexandre J. S.; Parker, Philip D.; Kaur, Gurvinder

    2015-01-01

    (This study examines the directionality of the associations among cognitive assets (IQ, academic achievement), motivational beliefs (academic self-concept, task values), and educational and occupational aspirations over time from late adolescence (Grade 10) into early adulthood (5 years post high school). Participants were from a nationally…

  8. Parentification and Resilience among Students with Clinical and Nonclinical Aspirations: A Cross-Sectional Quantitative Study

    Science.gov (United States)

    Yew, Wan Ping; Siau, Ching Sin; Kwong, Su Fong

    2017-01-01

    This study examined the relationship between level of parentification and resilience among students with clinical and nonclinical aspirations in Malaysia. A total of 419 college students were surveyed using the Parentification Questionnaire (Jurkovic & Thirkield, 1998) and Connor-Davidson Resilience Scale (Connor & Davidson, 2003). Results…

  9. Aspirations of Chicano Youth from the Texas Border Region: A Metropolitan-Nonmetropolitan Comparison.

    Science.gov (United States)

    Kuvlesky, William P.; Venegas, Moises

    The document tested the level of generalization of a recent conclusion from past research (see ED075156) on nonmetropolitan (NM) south and southwest Texas Mexican American teenagers: that these youths have predominantly high and strong status aspirations and expectations. Earlier findings on NM Mexican American youth supported Merton's thesis that…

  10. A Study of Female Central Office Administrators and Their Aspirations to the Superintendency

    Science.gov (United States)

    Muñoz, Ava J.; Pankake, Anita; Ramalho, Elizabeth Murakami; Mills, Shirley; Simonsson, Marie

    2014-01-01

    The purpose of this research is to examine the motivations of females aspiring to school superintendency positions in Texas. We report on a reanalysis of data from two previous studies and how the findings build an understanding of previously documented obstacles and barriers female candidates encounter in their journey toward the superintendency.…

  11. Parentification and Resilience among Students with Clinical and Nonclinical Aspirations: A Cross-Sectional Quantitative Study

    Science.gov (United States)

    Yew, Wan Ping; Siau, Ching Sin; Kwong, Su Fong

    2017-01-01

    This study examined the relationship between level of parentification and resilience among students with clinical and nonclinical aspirations in Malaysia. A total of 419 college students were surveyed using the Parentification Questionnaire (Jurkovic & Thirkield, 1998) and Connor-Davidson Resilience Scale (Connor & Davidson, 2003). Results…

  12. Aspirations and sex: Coming of age in western Kenya in a context of HIV

    NARCIS (Netherlands)

    Blommaert, E.

    2014-01-01

    This dissertation is rooted in the daily life worlds of young people between the ages of 16 and 25 in a rural area of western Kenya (called ‘Winam’). It seeks to draw our attention to young people’s hopes, aspirations, and expectations, and shows how these young people creatively construct their

  13. Medical versus surgical abortion efficacy, complications and leave of absence compared in a partly randomized study

    DEFF Research Database (Denmark)

    Rørbye, Christina; Nørgaard, Mogens; Nilas, Lisbeth

    2004-01-01

    antibiotic treatment, leave of absence and number of contacts to the health care system were obtained from mailed questionnaires. The number of complications was identical after the two methods, but surgical abortion was associated with a higher success rate [97.7% (708/725) vs. 94.1% (386/410), p ... gemeprost) or a surgical abortion (vacuum aspiration in general anesthesia). One hundred eleven of these women were randomized for abortion method. Surgical interventions and complications leading to readmission within the following 15 weeks were identified through a computer system. Information about......] and also with a higher risk of antibiotic treatment than medical abortion [7.8% (37/467) vs. 3.7% (13/356), p leave of absence was shorter in women choosing a medical (1 day) than a surgical termination (2 days), p

  14. Access to Rehabilitation at Six Months Post Stroke: A Profile from the Action on Secondary Prevention Interventions and Rehabilitation in Stroke (ASPIRE-S) Study.

    Science.gov (United States)

    Hall, Patricia; Williams, David; Hickey, Anne; Brewer, Linda; Mellon, Lisa; Dolan, Eamon; Kelly, Peter J; Shelley, Emer; Horgan, N Frances

    2016-01-01

    Stroke is the third leading cause of death and disability. Few studies have assessed the profile and adequacy of access to rehabilitation services after ischaemic stroke both in the inpatient and community setting. The objectives of the Action on Secondary Prevention Interventions and Rehabilitation in Stroke (ASPIRE-S) study were to assess the disability and rehabilitation profile, adherence with rehabilitation recommendations and needs of patients 6 months following hospital admission for stroke. A rehabilitation prescription was completed before hospital discharge for each participant, and adherence to this prescription was assessed at 6 months to determine whether patients received their recommended rehabilitation needs. Two hundred and fifty six patients were recruited to ASPIRE-S. The average age was 69 (SD 12.8). A majority (n = 221, 86%) were referred to the hospital multidisciplinary team, 59% (n = 132) were referred to all services (physiotherapy (PT), occupational therapy (OT), speech and language therapy (SLT)). Fifty-four percent (n = 119) of patients (seen by the multidisciplinary team) were referred for further rehabilitation in the community on discharge. Of these 119 patients, 112 (95%) recalled receiving community rehabilitation services. However, while most (68%) patients were referred for several disciplines (PT, OT, SLT), the most commonly recalled therapy (55%) was from a single discipline. The most commonly recommended frequency of therapy required was on a weekly basis. Sixty-one patients (51%) reported a delay in services, with some still awaiting services at 6 months. Results from this prospective study revealed that a significant number of patients (57%) did not receive the therapy recommended on discharge. Future initiatives should include the development of policies, which support more effective, equitable multidisciplinary rehabilitation for stroke patients in the community. © 2016 S. Karger AG, Basel.

  15. Sensory cutaneous nerve fine-needle aspiration in Hansen's disease: A retrospective analysis of our experience.

    Science.gov (United States)

    Prasoon, Dev; Mandal, Swapan Kumar; Agrawal, Parimal

    2015-01-01

    Leprosy affects peripheral nerves. As Mycobacterium leprae has unique tropism for Schwann cells, thickened sensory cutaneous nerves provide an easy target for the detection of lepra bacilli and other changes associated with the disease. The data of patients with sensory cutaneous nerve involvement were retrieved from our record for the period January 2006 to December 2014. The hematoxylin and eosin (H and E)- and May-Grünwald-Giemsa (MGG)-stained slides were screened for Schwann cells, granuloma, and necrosis. Modified Ziehl-Neelsen (ZN)-stained smears were searched for lepra bacilli and globi. Morphological index was calculated in multibacillary lesions. Twenty-nine sensory cutaneous nerves were aspirated in 23 patients. While 15 cases showed skin and nerve involvement, 8 cases showed only nerve involvement. Terminal cutaneous branch of the radial nerve was most often aspirated. No motor loss was observed after aspiration. Five cytologic pictures were seen - Epithelioid cell granuloma only in 6 cases, epithelioid cell granuloma with necrosis in 1 case, epithelioid cell granuloma with lepra bacilli in 3 cases, necrosis with lepra bacilli in 1 case, and only lepra bacilli in 12 cases. Morphological index ranged from 20% to 80%. Sensory cutaneous nerve fine-needle aspiration (FNA) is a feasible, viable, effective, and safe procedure. It adds to diagnostic FNA yield in patients with concomitant skin involvement and offers a way to evaluate patients with only nerve involvement. Calculation of morphological index allows prognostication and may have a role in assessing response to therapy and/or relapse.

  16. Aspiration pneumonia: With special reference to pathological and epidemiological aspects, a review of the literature

    Directory of Open Access Journals (Sweden)

    Kayo Kuyama

    2010-08-01

    Full Text Available Silent aspiration plays an important role in the pathogenesis of bacterial pneumonia in the elderly. Defense of the airway is impaired in the elderly by alteration in respiratory mechanics; decreased mucociliary clearance and immunosenescence. And, the number of microorganisms in the oral cavity of the elderly is usually larger than that of young adults because of gradual reduction in production of saliva. A relationship between poor oral health and respiratory disease has been suggested by a number of recent microbiologic and epidemiologic studies, especially in elder subjects; who requiring help with feeding, wearing denture/edentate, with periodontal disease, and so on. Several researchers have reported that using professional oral health care (POHC can prevent pneumonia. Oral/respiratory mucosal tissues produced cytokine that stimulated by oral microorganisms and were altered expression of various cell adhesion molecules on their surface in response to cytokine stimulation. Then, aspiration pneumonia histopathologically characterized with inflammatory response including macrophage infiltration was caused by aspiration of oral microorganisms, acid and food particle. In conclusion, silent aspiration may be a key risk factor for the pathogenesis of pneumonia in the elderly patients with poor oral hygiene.

  17. The Use of Cervical Auscultation to Predict Oropharyngeal Aspiration in Children: A Randomized Controlled Trial.

    Science.gov (United States)

    Frakking, Thuy T; Chang, Anne B; O'Grady, Kerry-Ann F; David, Michael; Walker-Smith, Katie; Weir, Kelly A

    2016-12-01

    In this study, we aimed to determine if the use of cervical auscultation (CA) as an adjunct to the clinical feeding evaluation (CFE + CA) improves the reliability of predicting oropharyngeal aspiration (abbreviated to aspiration) in children. The design of the study is based on open label, randomized controlled trial with concealed allocation. Results from children (CFE or CFE + CA were compared to videofluoroscopic swallow study (VFSS), the reference standard data. Aspiration was defined using the Penetration-Aspiration Scale. All assessments were undertaken at a single tertiary pediatric hospital. 155 children referred for a feeding/swallowing assessment were randomized into the CFE n = 83 [38 males; mean age = 34.9 months (SD 34.4)] or CFE + CA n = 72 [43 males; mean age = 39.6 months (SD 39.3)] group. kappa statistic, sensitivity, and specificity values, area under receiver operating curve (aROC). No significant differences between groups were found, although CFE + CA (kappa = 0.41, 95 % CI 0.2-0.62) had higher agreement for aspiration detection by VFSS, compared to the clinical feeding exam alone (kappa = 0.31, 95 % CI 0.10-0.52). Sensitivity was 85 % (95 % CI 62.1-96.8) for CFE + CA and 63.6 % (95 % CI 45.1-79.6) for CFE. aROC was not significantly greater for CFE + CA (0.75, 95 % CI 0.65-0.86) than CFE (0.66, 95 % CI 0.55-0.76) across all age groups. Although using CA as an adjunct to the clinical feeding evaluation improves the sensitivity of predicting aspiration in children, it is not sensitive enough as a diagnostic tool in isolation. Given the serious implications of missing the diagnosis of aspiration, instrumental assessments (e.g., VFSS), remain the preferred standard.

  18. Medical versus surgical abortion: comparing satisfaction and potential confounders in a partly randomized study

    DEFF Research Database (Denmark)

    Rørbye, Christina; Nørgaard, Mogens; Nilas, Lisbeth

    2005-01-01

    .05. Satisfaction with the medical procedure was inversely correlated with GA and the intensity of pain, nausea, vomiting and dizziness, while satisfaction with the surgical procedure was unaffected by these side effects. Fewer women with a failed medical than a failed surgical abortion were satisfied (17% vs 62......) or a surgical abortion (vacuum aspiration in general anaesthesia). The procedure was determined either by randomization (n = 111) or by choice (n = 922). Data on satisfaction, side effects and expectations were collected from questionnaires 2 and 8 weeks after termination. RESULTS: More women were very......BACKGROUND: The aim of the study was to compare satisfaction with medical and surgical abortion and to identify potential confounders affecting satisfaction. METHODS: 1033 women with gestational age (GA) medical (600 mg mifepristone followed by 1 mg gemeprost...

  19. Medical versus surgical abortion efficacy, complications and leave of absence compared in a partly randomized study

    DEFF Research Database (Denmark)

    Rørbye, Christina; Nørgaard, Mogens; Nilas, Lisbeth

    2004-01-01

    antibiotic treatment, leave of absence and number of contacts to the health care system were obtained from mailed questionnaires. The number of complications was identical after the two methods, but surgical abortion was associated with a higher success rate [97.7% (708/725) vs. 94.1% (386/410), p ...To provide optimal information to women choosing between early medical and surgical abortion, rigorous comparisons of the two methods are warranted. We compared the outcome of 1135 consecutive women with gestational age (GA) ... gemeprost) or a surgical abortion (vacuum aspiration in general anesthesia). One hundred eleven of these women were randomized for abortion method. Surgical interventions and complications leading to readmission within the following 15 weeks were identified through a computer system. Information about...

  20. Endoscopic ultrasound-guided fine-needle aspiration biopsy (EUS-FNA) in insulinomas: Indications and clinical relevance in a single investigator cohort of 47 patients.

    Science.gov (United States)

    Kann, Peter Herbert; Moll, Roland; Bartsch, Detlef; Pfützner, Andreas; Forst, Thomas; Tamagno, Gianluca; Goebel, Joachim N; Fourkiotis, Verena; Bergmann, Simona Raluca; Collienne, Maike

    2017-04-01

    This study was aimed to investigate the role and relevance of endoscopic ultrasound-guided fine-needle aspiration biopsy in the diagnostic work-up of insulinomas. We have analysed the frequency, clinical indications, success rate (obtaining diagnostic tissue), diagnostic accuracy (in comparison to the pathological diagnosis after surgery), complications, and tolerability of endoscopic ultrasound-guided fine-needle aspiration biopsy and the localization and size of the lesions in 47 consecutive patients (29 females, 18 males; 46 ± 15 years) who had surgery for insulinoma following fasting test and were explored by single investigator EUS 1994-2015. Endoscopic ultrasound-guided fine-needle aspiration biopsy was performed in 21 % (10/47) of the patients. The clinical indications for endoscopic ultrasound-guided fine-needle aspiration biopsy were non-conclusive result of fasting test (n = 7), missing toxicology (n = 2), suspected malignancy at EUS (n = 1), suspicious extra-pancreatic localization of the lesion (n = 1). The diagnostic success rate of the procedure was 80 % (8/10 cases), the diagnostic accuracy of the fine-needle aspiration biopsy 70 % (7/10 cases). The lesions undergoing endoscopic ultrasound-guided fine-needle aspiration biopsy were localized in the cauda (n = 5), corpus (n = 2), caput/processus uncinatus (n = 3), the diameter of the tumors was 21 ± 18 (10-70) mm. Only one accidental vascular puncture without any clinical complication occurred and all patients tolerated the procedure well. In the majority of cases, positive fasting test, negative toxicology, and detection of a typical pancreatic lesion at endoscopic ultrasound is sufficient for the diagnosis of insulinoma and the definition of the appropriate surgical strategy. Based on our data, we suggest including endoscopic ultrasound-guided fine-needle aspiration biopsy in the diagnostic work-up of organic hyperinsulinism in selected patients with

  1. A Clinical Study on Management of Incomplete Abortion by Manual Vacuum Aspiration (MVA

    Directory of Open Access Journals (Sweden)

    Arifa Akter Jahan

    2012-07-01

    Full Text Available Background: Abortion is an important social and public health issue. In Bangladesh complication from unsafe abortion is one of the leading causes of maternal mortality. It is a serious health problem. World Health Organisation estimates that 14% of maternal deaths which occur every year in the countries of South Asia including Bangladesh are due to abortion. Study shows manual vacuum aspiration procedure is safe and effective in incomplete abortion. Very few clinical trials were carried out in Bangladesh to assess the safety and effectivity of manual vacuum aspiration in managing incomplete abortion. Objective: To find out the outcome of manual vacuum aspiration in the management of patients of incomplete abortion. Materials and Methods: This observational descriptive study was conducted in the department of Obstetrics & Gynaecology, Dhaka Medical College & Hospital from June to December, 2004. One hundred cases of diagnosed incomplete abortion up to 12 weeks of gestation were managed by manual vacuum aspiration during this period. A data recording sheet was designed for this purpose. Haemodynamically stable patients with no history of induced abortion and fever were enrolled. Results: Procedure time of manual vacuum aspiration was short, average duration was 7 minutes. Bleeding was minimum (20-30 mL in 67% cases and weighted mean was 29.80 mL. Eighty three percent patients were stable during the procedure and only 3% needed blood transfusion. Nonnarcotic analgesics were used in 59% cases and 33% needed only proper counselling. Average duration of hospital stay was 2 hours. Effectiveness of the procedure was about 98% with very low post procedure complication rate (2%. Conclusion: MVA procedure is a safe and effective technique of uterine evacuation in incomplete abortion. It is quick, less expensive, effective and less painful. Hospital stay and chance of perforation of uterus is less. So this procedure should be considered by health care

  2. Diagnostic value of fine needle aspiration biopsy in non-thyroidal head and neck lesions: a retrospective study of 866 aspiration materials.

    Science.gov (United States)

    Göret, Ceren Canbey; Göret, Nuri Emrah; Özdemir, Zeynep Tuğba; Özkan, Esra Akyüz; Doğan, Meryem; Yanık, Serdar; Gümrükçü, Gülistan; Aker, Figen Vardar

    2015-01-01

    We aimed to investigate the diagnostic value of fine needle aspiration biopsy (FNAB) and compared our FNAB results of non-thyroidal head and neck lesions with excisional biopsy results. A total of 866 aspiration material taken from different parts of head and neck region out of thyroid were evaluated at Haydarpasa Numune Training and Research Hospital Pathology Laboratory, between January 2002 and May 2013 and 248 of which has histopathologic response were included in the study. Patients depending on origin of the masses were divided into three categories as; salivary gland, lymph nodes and soft tissue/cystic lesions. The sensitivity, specificity, diagnostic accuracy values of fine needle aspiration biopsies have been investigated for all the series and individually for each category. Diagnostic sensitivity, specificity, accuracy, positive predictive value and negative predictive values of non-thyroidal head and neck masses were respectively; For all of the series; 94.6%, 97.9%, 96.7%, 95.9%, 97.2%, Salivary gland: 88.9%, 100%, 98.8%, 100%, 98.7%, Lymph nodes: 94.7%, 89.3%, 92.9%, 94.7%, 89.2%, Soft tissue/cystic lesions: 100%, 100%, 100%, 100%, 100%. For all of the series; there were 4 false negative (FN) cases; and 3 false positive (FP) cases. FNAB in the diagnosis of head and neck masses; it is an easy, cheap and usefull procedure.

  3. Ultrasound-guided Transvaginal Aspiration in the Management of Actinomyces Pelvic Abscess

    Science.gov (United States)

    Rahav, Galiya; Hanoch, Josef; Shimonovitz, Shlomo; Yagel, Simcha; Laufer, Neri

    1996-01-01

    Background: Increasing reports of intrauterine device (IUD)-related abdominopelvic actinomycosis have been described recently. Surgical therapy has been the usual treatment when tubo-ovarian abscess is identified. Case: A 38-year-old woman suffering from Actinomyces pelvic abscess unresponsive to medical treatment underwent transvaginal ultrasound-guided needle aspiration. It resulted in marked improvement and avoided surgical treatment. Conclusion: Transvaginal needle aspiration of Actinomyces pelvic abscess may be an alternative to surgical therapy, thereby allowing the preservation of pelvic organs. PMID:18476111

  4. In vitro evaluation of a micro-Doppler catheter for detection and aspiration of venous air emboli.

    Science.gov (United States)

    Bigeleisen, Paul E

    2007-11-01

    Venous air embolism (VAE) is a potentially fatal complication of surgery when open veins at a surgical site are exposed to ambient air pressure which exceeds the pressure in the venous system. Common techniques of detecting VAE are precordial Doppler monitoring and transesophogeal echocardiography. Precordial Doppler monitoring has poor accuracy and transesophogeal echocardiography is expensive and user-intensive. In both methods, a separate catheter must be inserted into the vena cava so that an embolus may be aspirated if it is detected. We created a micro-Doppler assembly using two ceramic transducers fitted over a 5.8F multiorifice central venous catheter. This micro-Doppler catheter (MDC) was tested in vitro using a static tank and an artificial vena cava (AVC). The MDC was also tested for acoustic pressure and current leakage in the static tank and for heat generation and cavitation in the AVC. The MDC was able to detect bubbles more than 2 mm in diameter with 100% accuracy. A blinded observer was able to identify the onset of vapor lock in 10 of 10 trials. The same observer was able to terminate vapor lock in 10 of 10 trials. The acoustic pressures measured were <1.8 MPa. There was no increase in temperature in the AVC over 24 h and there was no evidence of cavitation in the AVC over 4 h. We have created a MDC that can detect air emboli and relieve vapor lock in a simulated vena cava and atrium. This catheter could be placed percutaneously in the vena cava. Based on the measurements of acoustic pressure, temperature in the AVC and lack of cavitation in the AVC, the device appears to be safe for use in humans. More studies are required to determine if the catheter could be used to detect and aspirate VAE during surgeries where VAE is likely, such as sitting craniotomy.

  5. CAREER ASPIRATION VIS-À-VIS INTERPERSONAL RELATIONSHIP – A STUDY ON SINGLE AND IN-A-RELATIONSHIP STUDENTS

    OpenAIRE

    Swaha Bhattacharya; Rima Bhattacharya

    2014-01-01

    Career aspiration is the strong desire or goal to have a good career. Career aspiration refers to simply the goals that set out to achieve in either one’s current profession or one’s desired profession. An interpersonal relationship is an association between the two or more people that may range from fleeting to enduring. This association may be based on inference, love, solidarity, regular business interactions, or some other types of social commitment. The aim of the present investigation i...

  6. A randomized controlled trial of peeling and aspiration of Elschnig pearls and neodymium: yttrium-aluminiumgarnet laser capsulotomy

    Institute of Scientific and Technical Information of China (English)

    Rahul; Bhargava; Prachi; Kumar; Shiv; Kumar; Sharma; Avinash; Kaur

    2015-01-01

    AIM: To compare surgical peeling and aspiration and neodymium yttrium garnet laser capsulotomy for pearl form of posterior capsule opacification(PCO).METHODS: A prospective, randomized, double blind,study was done at Rotary Eye Hospital, Maranda,Palampur, India, Santosh Medical College Hospital,Ghaziabad, India and Laser Eye Clinic, Noida India.Consecutive patients with pearl form of PCO following surgery, phacoemulsification, manual small incision cataract surgery and conventional extracapsular cataract extraction(ECCE) for age related cataract, were randomized to have peeling and aspiration or neodymium yttrium garnet laser capsulotomy. Corrected distance visual acuity(CDVA), intra-operative and postoperative complications were compared.RESULTS: A total of 634 patients participated in the study, and 314(49.5%) patients were randomized to surgical peeling and aspiration group and 320(50.5%) to the Nd:YAG laser group. The mean pre-procedural log MAR CDVA in peeling and neodymium: yttrium-aluminium-garnet(Nd:YAG) laser group was 0.80 ±0.25 and 0.86 ±0.22, respectively. The mean final CDVA in peeling group(0.22 ±0.23) was comparable to Nd:YAG group(0.24 ±0.28; t-test, P =0.240). There was a significant improvement in vision after both the procedures(P <0.001). A slightly higher percentage of patients in Nd:YAG laser group(283/88.3%) than in peeling group(262/83.4%) had a CDVA of 0.5(20/63) or better at 9mo(P <0.001). On the contrary, patients havingCDVA worse than 1.00(20/200) was also significantly higher in Nd:YAG laser group as compared to peeling group(25/7.7% vs 15/4.7%, respectively). On application of ANCOVA, there was less than 0.001% risk that PCO thickness and total laser energy had no effect on rate of complications in Nd:YAG laser group and less than 0.001% risk that PCO thickness had no effect on complications in peeling group respectively. Sum of square analysis suggests that in the Nd:YAG laser group,thick PCO had a stronger impact on complications

  7. Bilateral spontaneous pneumothorax secondary to aspiration pneumonia induced by a wristwatch lodged at the pharyngoesophageal junction.

    Science.gov (United States)

    Kawai, Chihiro; Miyao, Masashi; Kotani, Hirokazu; Tamaki, Keiji

    2015-06-01

    Bilateral spontaneous pneumothorax secondary to disease is rare and seldom encountered in forensic autopsies; however, traumatic bilateral pneumothorax occurs often. Herein, we present a forensic case involving a 50-year-old woman who died 4 days after ingesting a wristwatch. Postmortem computed tomography and autopsy findings demonstrated that the wristwatch was lodged at the pharyngoesophageal junction, that she had a bilateral pneumothorax unaccompanied by any thoracic wound, and that macular hemorrhagic lesions on the lung surfaces were responsible for the pneumothorax. A histological examination of the macular lesions revealed that they were aspiration pneumonia foci with many birefringent foreign materials. Furthermore, a necrotic process secondary to aspiration pneumonia with a one way check-valve hyperinflation caused by foreign materials in the bronchioles was the most probable pathogenesis of her pneumothorax. To our knowledge, this is the first reported case of a bilateral secondary spontaneous pneumothorax caused by a large foreign body at the pharyngoesophageal junction leading to death.

  8. EUS – Fine- Needle Aspiration Biopsy (FNAB in the Diagnosis of Pancreatic Adenocarcinoma: A Review

    Directory of Open Access Journals (Sweden)

    Kalogeraki Alexandra

    2016-03-01

    Full Text Available Solid masses of the pancreas represent a variety of benign and malignant neoplasms of the exocrine and endocrine tissues of the pancreas. A tissue diagnosis is often required to direct therapy in the face of uncertain diagnosis or if the patient is not a surgical candidate either due to advanced disease or comorbidities. Endoscopic ultrasound (EUS is a relatively new technology that employs endoscopy and high-frequency ultrasound (US. EUS involves imaging of the pancreatic head and the uncinate from the duodenum and imaging of the body and tail from the stomach. It has been shown to be a highly sensitive method for the detection of pancreatic masses. It is superior to extracorporeal US and computed tomographic (CT scans, especially when the pancreatic tumor is smaller than 2-3 cm. Although EUS is highly sensitive in detecting pancreatic solid masses, its ability to differentiate between inflammatory masses and malignant disease is limited. Endoscopic retrograde cholangiopancreatography (ERCP brushing, CT-guided biopsies, and transabdominal ultrasound (US have been the standard nonsurgical methods for obtaining a tissue diagnosis of pancreatic lesions, but a substantial false-negative rate has been reported. Transabdominal US-guided fine-needle aspiration biopsy (US-FNAB has been used for tissue diagnosis in patients with suspected pancreatic carcinoma. It has been shown to be highly specific, with no false-positive diagnoses. With the advent of curvilinear echoendoscopes, transgastric and transduodenal EUS-FNAB of the pancreas have become a reality EUS with FNAB has revolutionized the ability to diagnose and stage cancers of the gastrointestinal tract and assess the pancreas. Gastrointestinal cancers can be looked at with EUS and their depth of penetration into the intestinal wall can be determined. Any suspicious appearing lymph nodes can be biopsied using EUS/FNAB. The pancreas is another organ that is well visualized with EUS. Abnormalities

  9. In vivo measurement of human brain elasticity using a light aspiration device

    CERN Document Server

    Schiavone, Patrick; Boudou, Thomas; Promayon, Emmanuel; Valdivia, F; Payan, Yohan

    2009-01-01

    The brain deformation that occurs during neurosurgery is a serious issue impacting the patient "safety" as well as the invasiveness of the brain surgery. Model-driven compensation is a realistic and efficient solution to solve this problem. However, a vital issue is the lack of reliable and easily obtainable patient-specific mechanical characteristics of the brain which, according to clinicians' experience, can vary considerably. We designed an aspiration device that is able to meet the very rigorous sterilization and handling process imposed during surgery, and especially neurosurgery. The device, which has no electronic component, is simple, light and can be considered as an ancillary instrument. The deformation of the aspirated tissue is imaged via a mirror using an external camera. This paper describes the experimental setup as well as its use during a specific neurosurgery. The experimental data was used to calibrate a continuous model. We show that we were able to extract an in vivo constitutive law of ...

  10. Ultrasound-guided hydrosalpinx aspiration during oocyte collection improves pregnancy outcome in IVF: a randomized controlled trial.

    Science.gov (United States)

    Hammadieh, Nahed; Coomarasamy, Arri; Ola, Bolarinde; Papaioannou, Spyros; Afnan, Masoud; Sharif, Khaldoun

    2008-05-01

    Hydrosalpinges have adverse effects on IVF outcomes. Salpingectomy is effective in improving outcomes, but it is not always practical or safe. Ultrasound-guided aspiration of hydrosalpinges at oocyte collection is an option for those who develop hydrosalpinges during controlled ovarian stimulation; however, there is no randomized evidence to show whether this practice is effective. Between October 1999 and June 2003, consenting women of age aspiration of hydrosalpinx under antibiotics cover or no aspiration. Third-party randomization was performed using a computer algorithm, and allocation concealment was achieved with opaque sealed envelopes. Outcomes were biochemical and clinical pregnancies, implantation, spontaneous abortion, ectopic pregnancy and pelvic infection rates. Analysis was by intention to treat. Sixty-six women were recruited to the trial, 32 to the aspiration group and 34 to the no-aspiration group. Aspiration resulted in a greater biochemical pregnancy rate [14/32 (43.8%) versus 7/34 (20.6%), relative risk (RR) = 2.1 (1.02, 4.6), P = 0.04]. Clinical pregnancy rates for aspiration versus control groups were 31.3% (10/32) and 17.6% (6/34), respectively [RR = 1.8 (0.8, 4.3), P = 0.20]. There were no changes in implantation rate or spontaneous abortion risk with aspiration and no differences between the groups in infection or ectopic pregnancy rates. In women who are identified to have hydrosalpinges during controlled ovarian stimulation during IVF, aspiration of hydrosalpinges during oocyte collection may be effective in improving pregnancy rates (Trial Registration Number: NCT00566956).

  11. Female Leadership Raises Aspirations and Educational Attainment for Girls: A Policy Experiment in India

    Science.gov (United States)

    Beaman, Lori; Duflo, Esther; Pande, Rohini; Topalova, Petia

    2012-01-01

    Exploiting a randomized natural experiment in India, we show that female leadership influences adolescent girls’ career aspirations and educational attainment. A 1993 law reserved leadership positions for women in randomly selected village councils. Using 8,453 surveys of adolescents aged 11–15 and their parents in 495 villages, we find that, compared to villages that were never reserved, the gender gap in aspirations closed by 25% in parents and 32% in adolescents in villages assigned to a female leader for two election cycles. The gender gap in adolescent educational attainment is erased and girls spent less time on household chores. We find no evidence of changes in young women’s labor market opportunities, suggesting that the impact of women leaders primarily reflects a role model effect. PMID:22245740

  12. Diagnostic problems in fine needle aspiration cytology of fat necrosis within a subcutaneous lipoma

    Directory of Open Access Journals (Sweden)

    Kavishwar Vikas

    2008-01-01

    Full Text Available Fat necrosis in subcutaneous lipomas is very unusual and has been reported only occasionally. Literature regarding fine needle aspiration cytology of such a lesion is lacking although fat necrosis is well described in the breast. We came across a case of a large subcutaneous lipoma in the anterior abdominal wall with a well encapsulated area of fat necrosis. The aspiration smears showed an unusual picture which was misinterpreted as the fragments of the hydatid cyst wall. They were actually enlarged, nonnucleate, single adipocytes showing laminations, along with calcification and paucity of inflammation. Histopathology confirmed the diagnosis of fat necrosis within the lipoma. Such lesions can be mistaken on radiology for malignancy.

  13. Female leadership raises aspirations and educational attainment for girls: a policy experiment in India.

    Science.gov (United States)

    Beaman, Lori; Duflo, Esther; Pande, Rohini; Topalova, Petia

    2012-02-03

    Exploiting a randomized natural experiment in India, we show that female leadership influences adolescent girls' career aspirations and educational attainment. A 1993 law reserved leadership positions for women in randomly selected village councils. Using 8453 surveys of adolescents aged 11 to 15 and their parents in 495 villages, we found that, relative to villages in which such positions were never reserved, the gender gap in aspirations closed by 20% in parents and 32% in adolescents in villages assigned a female leader for two election cycles. The gender gap in adolescent educational attainment was erased, and girls spent less time on household chores. We found no evidence of changes in young women's labor market opportunities, which suggests that the impact of women leaders primarily reflects a role model effect.

  14. Should fine needle aspiration biopsy be the first pathological investigation in the diagnosis of a bone lesion? An algorithmic approach with review of literature

    Directory of Open Access Journals (Sweden)

    Mehrotra Ravi

    2007-01-01

    Full Text Available Abstract Background Fine needle aspiration biopsy (FNAB is gaining increasing popularity in the diagnosis of musculoskeletal lesions; and in many patients, a definitive diagnosis can be rendered from aspiration smears alone. Its applicability in bone pathology, however, has been controversial due to a high percentage of inadequate smears, difficulty in evaluation of tissue architecture and nonspecific results in the diagnosis of primary bone lesions. In this study, the value of aspiration as the first pathological investigation in the diagnosis of a bone lesion was evaluated. Methods 91 cases of clinically suspected cases of bone lesions were aspirated over a period of two years. Direct or cytospin smears were fixed in 95% alcohol and stained by Hematoxylin and Eosin or air-dried and later fixed in methanol for May Grŭnwald Giemsa staining. Results Of the 91 patients who were subjected to FNAB, 81 were considered satisfactory and 10.9 % (10 were inadequateinconclusive for diagnosis. Cyto-histological concordance was obtained in 78.5 % (51/65 patients. Positive and negative predictive values were 87.5% and 97.2 % respectively. Sensitivity as a preliminary diagnostic technique was 93.3%, whereas specificity was 94.5 %. Overall, diagnostic accuracy was 94.2 %. Metastatic lesions were detected with 100% accuracy. Two cases were reported as false positive and one case as false negative. Conclusion Cytology provides valuable information to the clinician to make an informed decision regarding appropriate therapy. We conclude that time-consuming and costly investigations may be reduced by choosing FNAB as the initial pathological diagnostic method for skeletal lesions of unknown origin. The choice of radiological examinations, laboratory tests and surgical biopsies can be determined after the FNAB diagnosis.

  15. Human Beings’Forever Aspiration for Love-Review of A Haunted House

    Institute of Scientific and Technical Information of China (English)

    于彤; 单晓晶

    2013-01-01

      In this essay, I will explore human being’s aspiration for love conveyed in the novel A Haunted House by Virginia Woolf. The exploration starts from the analysis of the ghostly couple’s horror for death, the living couples dreaming of the ghostly cou⁃ples' finding of the treasure of love, and finally to the description of the loving scenes of this couple.

  16. Diffraction enhanced imaging of a rat model of gastric acid aspiration pneumonitis.

    Science.gov (United States)

    Connor, Dean M; Zhong, Zhong; Foda, Hussein D; Wiebe, Sheldon; Parham, Christopher A; Dilmanian, F Avraham; Cole, Elodia B; Pisano, Etta D

    2011-12-01

    Diffraction-enhanced imaging (DEI) is a type of phase contrast x-ray imaging that has improved image contrast at a lower dose than conventional radiography for many imaging applications, but no studies have been done to determine if DEI might be useful for diagnosing lung injury. The goals of this study were to determine if DEI could differentiate between healthy and injured lungs for a rat model of gastric aspiration and to compare diffraction-enhanced images with chest radiographs. Radiographs and diffraction-enhanced chest images of adult Sprague Dawley rats were obtained before and 4 hours after the aspiration of 0.4 mL/kg of 0.1 mol/L hydrochloric acid. Lung damage was confirmed with histopathology. The radiographs and diffraction-enhanced peak images revealed regions of atelectasis in the injured rat lung. The diffraction-enhanced peak images revealed the full extent of the lung with improved clarity relative to the chest radiographs, especially in the portion of the lower lobe that extended behind the diaphragm on the anteroposterior projection. For a rat model of gastric acid aspiration, DEI is capable of distinguishing between a healthy and an injured lung and more clearly than radiography reveals the full extent of the lung and the lung damage. Copyright © 2011 AUR. All rights reserved.

  17. Implementing oral care to reduce aspiration pneumonia amongst patients with dysphagia in a South African setting

    Directory of Open Access Journals (Sweden)

    Jaishika Seedat

    2016-02-01

    Full Text Available Oral care is a crucial routine for patients with dysphagia that, when completed routinely, can prevent the development of aspiration pneumonia. There is no standardised protocol for oral care within government hospitals in South Africa. This study aimed to investigate the outcome of an oral care protocol. Participants were patients with oropharyngeal dysphagia, with either stroke or traumatic brain injury as the underlying medical pathology, and nurses. All participants were recruited from one tertiary level government hospital in Gauteng, South Africa. 139 nurses participated in the study and received training on the oral care protocol. There were two groups of participants with oropharyngeal dysphagia. Group one (study group, n = 23 was recruited by consecutive sampling, received regular oral care and were not restricted from drinking water; however, all other liquids were restricted. Group two (comparison group, n = 23 was recruited via a retrospective record review, received inconsistent oral care and were placed on thickened liquids or liquid restricted diets. Results showed that a regimen of regular oral care and free water provision when combined with dysphagia intervention did prevent aspiration pneumonia in patients with oropharyngeal dysphagia. The article highlights two key findings: that regular and routine oral care is manageable within an acute government hospital context and a strict routine of oral care can reduce aspiration pneumonia in patients with oropharyngeal dysphagia. An implication from these findings is confirmation that teamwork in acute care settings in developing contexts must be prioritised to improve dysphagia management and patient prognosis.

  18. Fine needle aspiration cytology: a useful technique for diagnosis of invasive fungal rhinosinusitis.

    Science.gov (United States)

    Singhal, Niti; Raghubanshi, Gunjan; Handa, Uma; Punia, R P S; Singhal, Surinder

    2013-09-01

    Mycotic infections are on the rise globally. Patients with invasive fungal infection of the paranasal sinuses often present with destructive mass lesions and mimic malignancy clinically and radiologically. To assess the utility of Fine needle aspiration cytology for early diagnosis of invasive fungal rhinosinusitis. Fine needle aspiration cytology was performed from the maxillary/ethmoid sinus in patients with a destructive mass lesion in the maxilla. Differential diagnoses were malignancy and fungal rhinosinusitis. In eight cases fungi were detected on initial examination whereas in a single case that was initially reported as giant cell lesion, hyphae could be identified within giant cells, on review. Smears showed inflammatory cells with variable numbers of eosinophils with neutrophils and histiocytes. Foreign body giant cells were seen in all cases. The fungi conformed to morphology of aspergillus in seven cases (77.78%); in two cases (22.22%), typing could not be done. Periodic acid Schiff and Grocott stains highlighted the fungi in all the cases. Fine needle aspiration is a simple technique that can be useful for diagnosis of fungal rhinosinusitis and to exclude malignancy. Search for fungus may be more aggressive in smears with many foreign body giant cells and inflammatory cells and in cases with a high clinical suspicion. Differentiation between aspergillus and mucor can be made with help of special stains. Aspergillus is the commonest agent isolated. Preoperative cytological diagnosis obviates the need for biopsy, saves time and helps to plan proper treatment.

  19. Sex Differences in the Determination of Adolescent Aspirations: A Review of Research.

    Science.gov (United States)

    Marini, Margaret Mooney

    1978-01-01

    Factors influencing levels of adolescent aspiration are reviewed, including socioeconomic background, academic ability, number of siblings, parental encouragement, mother's employment, academic performance, peer aspirations, dating, and participation in school activities. Although sex differences affect the formation of both educational and…

  20. "I can't fall behind!" Aspirations, technology and becoming a teacher in South Africa : research article

    National Research Council Canada - National Science Library

    Chigona, Wallace; Pucciarelli, Marta; Bladergroen, Moira; Sabiescu, Amalia; Bytheway, Andy; Cantoni, Lorenzo

    2014-01-01

    .... The paper draws on the results of a grounded theory study to examine the aspirations for professional development of undergraduate pre-service teachers in South Africa, and the extent to which...

  1. A Review of the Use of Fine-Needle Aspiration Biopsy of Mammary Tumors for Diagnosis and Research.

    Science.gov (United States)

    Tani, Edneia; Fuentes-Martinez, Nelson; Skoog, Lambert

    2017-01-01

    The article "Aspiration Biopsy of Mammary Tumors in Diagnosis and Research - A Critical Review of 2,200 Cases" by Zajicek et al. [Acta Cytol 1967;11:169-175] is composed of two separate parts as can be seen from the title. Both are, however, of great historical interest. The first describes the early days of fine-needle aspiration cytology diagnosis of breast lesions in particular carcinomas. The results are still impressive with a diagnostic accuracy close to 90%. The second deals with the effect of negative pressure on cell viability during the aspiration procedure. These studies were aimed at evaluating the usefulness of aspirated tumor cells to analyze the effects of therapy and the origin of tumor cells. © 2017 S. Karger AG, Basel.

  2. "A fine needle aspiration cytology in time saves nine" - cutaneous phaeohyphomycosis caused by Exophiala jeanselmei in a renal transplant patient: Diagnosis by fine needle aspiration cytology

    Directory of Open Access Journals (Sweden)

    Prashant Joshi

    2016-01-01

    Full Text Available Infections by dematiaceous fungi are an emerging group of infectious diseases worldwide with a variety of clinical presentations. Though generally localized, they can disseminate in immunocompromised settings, therefore, early diagnosis and prompt therapy can prevent significant morbidity and mortality in these patients. Fungi of genus Exophiala are common causative organisms; however, Exophiala jeanselmei (E. jeanselmei has not yet been reported from environmental sources in India. We present here the case of a renal transplant recipient who presented with an innocuous lesion on the foot, diagnosed on fine needle aspiration cytology (FNAC as phaeohyphomycosis, and promptly treated with excision and antifungal therapy. To the best of our knowledge, this is the first case report from India of E. jeanselmei causing phaeohyphomycosis in a transplant recipient and highlights the role a cytopathologist can play in the timely management of such cases.

  3. Safety of aspiration abortion performed by nurse practitioners, certified nurse midwives, and physician assistants under a California legal waiver.

    Science.gov (United States)

    Weitz, Tracy A; Taylor, Diana; Desai, Sheila; Upadhyay, Ushma D; Waldman, Jeff; Battistelli, Molly F; Drey, Eleanor A

    2013-03-01

    We examined the impact on patient safety if nurse practitioners (NPs), certified nurse midwives (CNMs), and physician assistants (PAs) were permitted to provide aspiration abortions in California. In a prospective, observational study, we evaluated the outcomes of 11 487 early aspiration abortions completed by physicians (n = 5812) and newly trained NPs, CNMs, and PAs (n = 5675) from 4 Planned Parenthood affiliates and Kaiser Permanente of Northern California, by using a noninferiority design with a predetermined acceptable risk difference of 2%. All complications up to 4 weeks after the abortion were included. Of the 11 487 aspiration abortions analyzed, 1.3% (n = 152) resulted in a complication: 1.8% for NP-, CNM-, and PA-performed aspirations and 0.9% for physician-performed aspirations. The unadjusted risk difference for total complications between NP-CNM-PA and physician groups was 0.87 (95% confidence interval [CI] = 0.45, 1.29) and 0.83 (95% CI = 0.33, 1.33) in a propensity score-matched sample. Abortion complications were clinically equivalent between newly trained NPs, CNMs, and PAs and physicians, supporting the adoption of policies to allow these providers to perform early aspirations to expand access to abortion care.

  4. A Stochastic Sprint in the Vague Direction of Data Science: Perspectives from a Graduate Student and Aspiring Data Scientist.

    Science.gov (United States)

    Barberie, S. R.

    2015-12-01

    Since data science does not exist as a stand-alone discipline within major universities, learning data science, or even learning that data science exists is, for an aspiring researcher at the graduate or undergraduate level, something that only happens by accident. Here I present my own series of accidents that transformed me from a somewhat aimless graduate student into an aspiring data scientist and the challenges that that aspiration has created in fitting into traditional academic programs and finding a coherent path forward. I also present my current conundrum: with the clear intention of pursuing data science but an academic background in other subjects, where do I go from here? Do I start my education over, pursue professional certification courses and bootcamp programs, or engage in not-very-marketable self study? This career chasm creates a strange environment for aspiring data scientists where we have a destination, but not a clear road to get there. I also discuss how joining a data focused interest group called The Federation of Earth Science Information Partners (ESIP) bridged some of the gap left by Academia in allowing me to network and collaborate with real data scientists from a variety of backgrounds. Organizations like this may someday play an important role in helping aspiring data scientists find their place, although for the moment many gaps and obstacles still remain, and the path forward is far from clear.

  5. Quantum like representation of aSpiral Phase Plate

    CERN Document Server

    Bovino, Fabio A

    2011-01-01

    We introduce a quantum like representation of a Spiral Phase Plate, acting on an electromagnetic field, as a two mode phase operator. The representation is based on the Newton binomial expansion and on properties of rational power of lowering and raising operators of quantum field. The correctness of this representation is proved by obtaining the same results of the Paul's operator in the single mode limit and comparing the results of two particular problems solved both in the classical and quantum picture: the action of a Spiral Phase Plate on a Gaussian Beam (corresponding to the vacuum state of the two-dimensional harmonic oscillator) and on a off-axis Gaussian Beam (corresponding to the displaced vacuum state in quantum picture).

  6. Severe sand aspiration: a case report with complete recovery.

    Science.gov (United States)

    Glinjongol, Chanin; Kiatchaipipat, Surachai; Thepcharoenniran, Somchai

    2004-07-01

    A 5-year-old boy, previously healthy, was admitted to Ratchaburi Hospital after being buried in a sand pile. He presented with dyspnea and tachypnea. Chest radiograph showed opaque particles in both main and segmental bronchi (sand bronchogram). The first attempt of bronchoscopy was unsatisfactory as a considerable amount of sand particles had migrated further into the distal bronchi. A second bronchoscopy was performed with 0.9% saline lavage. Most of the sand particles were successfully removed. Intravenous steroids and antibiotics were administered for treatment. The patient was discharged uneventfully by the end of the first week of hospitalization.

  7. Right Diaphragm Spontaneous Rupture: A Surgical Approach

    Directory of Open Access Journals (Sweden)

    Duilio Divisi

    2011-01-01

    Full Text Available We present a case of spontaneous rupture of the diaphragm, characterized by nonspecific symptoms. The rapid diagnosis and appropriate surgical approach led to a positive resolution of the pathology.

  8. Surgical infections: a microbiological study

    Directory of Open Access Journals (Sweden)

    Santosh Saini

    Full Text Available Surgical infections are mostly polymicrobial, involving both aerobes and anaerobes. One hundred seventeen cases comprised of abscesses (n=51, secondary peritonitis (n=25, necrotizing fascitis (n=22 and wounds with devitalized tissues (n=19 were studied. The number of microorganisms isolated per lesion was highest in secondary peritonitis (2.32. The aerobe/ anaerobe ratio was 0.81 in secondary peritonitis and 1.8 in necrotizing fascitis. Most secondary peritonitis (80%, necrotizing fascitis (75% and wounds with devitalized tissues (66.7% were polymicrobial. Common microorganisms isolated in our study were E. coli, Staphylococcus aureus, Klebsiella spp., Pseudomonas aeruginosa, Bacteroides fragilis and Peptostreptococcus spp. The most effective antibiotics for S. aureus were clindamycin (79.1% and cefuroxime (70.8%. For Gram-negatives (Klebsiella spp., E. coli and Proteus spp., the most effective antibiotics were cefotaxime, ceftizoxime, amikacin and ciprofloxacin. Pseudomonas aeruginosa was maximally sensitive to amikacin (35.2% and ciprofloxacin (35.2%. The greatest degree of multidrug resistance to all the drugs was found in P. aeruginosa (52.9%, followed by Klebsiella spp. (33.3%, Proteus spp. (33.3%, E. coli (22.2%, and S. aureus (12.5%. All the anaerobes that we isolated were 100% sensitive to metronidazole and chloramphenicol, followed by clindamycin (95% to 100%. Apart from antibiotic therapy, non-antimicrobial methods, such as hyperbaric oxygen therapy and debridement also play an important role in the treatment of surgical infections.

  9. Surgical infections: a microbiological study

    Directory of Open Access Journals (Sweden)

    Santosh Saini

    2004-04-01

    Full Text Available Surgical infections are mostly polymicrobial, involving both aerobes and anaerobes. One hundred seventeen cases comprised of abscesses (n=51, secondary peritonitis (n=25, necrotizing fascitis (n=22 and wounds with devitalized tissues (n=19 were studied. The number of microorganisms isolated per lesion was highest in secondary peritonitis (2.32. The aerobe/ anaerobe ratio was 0.81 in secondary peritonitis and 1.8 in necrotizing fascitis. Most secondary peritonitis (80%, necrotizing fascitis (75% and wounds with devitalized tissues (66.7% were polymicrobial. Common microorganisms isolated in our study were E. coli, Staphylococcus aureus, Klebsiella spp., Pseudomonas aeruginosa, Bacteroides fragilis and Peptostreptococcus spp. The most effective antibiotics for S. aureus were clindamycin (79.1% and cefuroxime (70.8%. For Gram-negatives (Klebsiella spp., E. coli and Proteus spp., the most effective antibiotics were cefotaxime, ceftizoxime, amikacin and ciprofloxacin. Pseudomonas aeruginosa was maximally sensitive to amikacin (35.2% and ciprofloxacin (35.2%. The greatest degree of multidrug resistance to all the drugs was found in P. aeruginosa (52.9%, followed by Klebsiella spp. (33.3%, Proteus spp. (33.3%, E. coli (22.2%, and S. aureus (12.5%. All the anaerobes that we isolated were 100% sensitive to metronidazole and chloramphenicol, followed by clindamycin (95% to 100%. Apart from antibiotic therapy, non-antimicrobial methods, such as hyperbaric oxygen therapy and debridement also play an important role in the treatment of surgical infections.

  10. FOREIGN BODY ASPIRATION IN CHILDREN: A HIDDEN DANGER

    Directory of Open Access Journals (Sweden)

    Marlene Rodrigues

    2016-09-01

    Conclusion: The aim of this report is to emphasize the need to maintain a high index of suspicion concerning the possibility of FBA, because the late recognition can lead to irreversible consequences.

  11. A porcine model for teaching surgical cricothyridootomy

    Directory of Open Access Journals (Sweden)

    Fernando Antonio Campelo Spencer Netto

    2015-06-01

    Full Text Available OBJECTIVE: To evaluate the acceptability of an educational project using A porcine model of airway for teaching surgical cricothyroidotomy to medical students and medical residents at a university hospital in southern Brazil.METHODS: we developed a teaching project using a porcine model for training in surgical cricothyroidotomy. Medical students and residents received lectures about this surgical technique and then held practical training with the model. After the procedure, all participants filled out a form about the importance of training in airway handling and the model used.RESULTS: There were 63 participants. The overall quality of the porcine model was estimated at 8.8, while the anatomical correlation between the model and the human anatomy received a mean score of 8.5. The model was unanimously approved and considered useful in teaching the procedure.CONCLUSION: the training of surgical cricothyroidotomy with a porcine model showed good acceptance among medical students and residents of this institution.

  12. A STUDY OF THE ASPIRATIONS OF MARRIED WOMEN COLLEGE GRADUATES.

    Science.gov (United States)

    LYON, RHEE

    THE PURPOSES OF THIS STUDY WERE TO DETERMINE WHAT HAPPENS TO CAREER AMBITIONS AFTER THE COLLEGE GIRL MARRIES, WHETHER INTERESTS AND AMBITIONS CHANGE IN SPECIFIC DIRECTIONS DURING MARRIAGE, AND IN WHAT WAYS MARRIED WOMEN WITH CAREER AMBITIONS DIFFER FROM THOSE WITH NONE. RESPONDENTS TO A FORCED-CHOICE QUESTIONNAIRE WERE 310 MEMBERS OF THE AMERICAN…

  13. Fine Needle Aspiration Biopsy in a Rural Family Practice

    African Journals Online (AJOL)

    Any patient with a suspicious mass that the family practitioner considered could be ... 25 (13%), lung 18 (10%), thyroid 5 (3%), breast 8 (4%) and other 4 (2%). .... were counseled on terminal care. ... cancer) of 67 %13 as compared to 17%.

  14. GEAR UP Aspirations Project Evaluation

    Science.gov (United States)

    Trimble, Brad A.

    2013-01-01

    The purpose of this study was to conduct a formative evaluation of the first two years of the Gaining Early Awareness and Readiness for Undergraduate Programs (GEAR UP) Aspirations Project (Aspirations) using a Context, Input, Process, and Product (CIPP) model so as to gain an in-depth understanding of the project during the middle school…

  15. Ultrasound-Guided Fine Needle Aspiration Biopsy of the Thyroid

    Science.gov (United States)

    ... Ultrasound-Guided Fine Needle Aspiration Biopsy of the Thyroid An ultrasound-guided thyroid biopsy uses sound waves ... Ultrasound-Guided Fine Needle Aspiration Biopsy of the Thyroid? During a fine needle aspiration biopsy of the ...

  16. Ultrasound-Guided Fine Needle Aspiration Biopsy of the Thyroid

    Science.gov (United States)

    ... News Physician Resources Professions Site Index A-Z Ultrasound-Guided Fine Needle Aspiration Biopsy of the Thyroid ... Needle Aspiration Biopsy of the Thyroid? What is Ultrasound-Guided Fine Needle Aspiration Biopsy of the Thyroid? ...

  17. Accidental aspiration of head scarf pin in left bronchus piercing the lung parenchyma: A rare case in a child

    Science.gov (United States)

    Parvez, Yusuf; Kandath, Mohammed Ashraf

    2016-01-01

    Foreign body (FB) aspiration is commonly seen in children but less commonly in adolescents. Headscarf pin aspiration is common in Muslim girls, who inappropriately place the pins between their lips while securing the scarf on the head. Bronchoscopy is the treatment modality of choice, and surgery is rarely required. An 11-year-old girl was admitted as a case of accidental aspiration of headscarf pin. X-ray chest showed a radiopaque object in the left bronchus piercing the lung parenchyma. Computed tomography (CT) chest confirmed the diagnosis. The headscarf pin was removed by flexible bronchoscopy as the ear, nose, and throat (ENT) surgeon failed to remove it by rigid bronchoscopy. The FB was removed successfully and the patient was discharged home. Removal of a sharp pin by bronchoscopy is difficult, especially if it pierces the lung parenchyma. In our case, the pin was bent by forceps and then removed by a flexible bronchoscope, which requires a highly skilled professional. PMID:27578937

  18. Surgical excision of the parotid salivary gland for treatment of a traumatic mucocele in a dog.

    Science.gov (United States)

    Guthrie, Kathleen M; Hardie, Robert J

    2014-01-01

    A 3 yr old spayed female mixed-breed German shepherd dog was presented with a right facial swelling that developed after fighting with another dog. A parotid salivary mucocele was diagnosed via physical examination, fine-needle aspirate, and sialography of the parotid and mandibular salivary glands. Surgical excision of the right parotid salivary gland and duct was performed along with drainage of the mucocele. Neither intraoperative nor postoperative complications occurred, and follow-up examination 4 mo later revealed no evidence of recurrence. Case outcome was considered excellent. Sialography was useful for confirming the parotid gland as the source of the mucocele. Surgical excision of the parotid salivary gland is technically challenging, but an effective treatment option for traumatic mucoceles in the dog.

  19. Drain removal and aspiration to treat low output chylous fistula.

    Science.gov (United States)

    Dhiwakar, Muthuswamy; Nambi, G I; Ramanikanth, T V

    2014-03-01

    Chylous fistula following neck dissection is difficult to treat. We hypothesized that timely removal of the suction drain followed by daily aspiration might aid in resolution of the condition. The study model is prospective cohort study. Out of 170 consecutive neck dissections, 7 (4 %) developed chylous fistula postoperatively. Retaining the suction drain was associated with resolution of the fistula in only one case. The remaining six had peak 24 h outputs between 85 and 675 ml that showed no significant fall despite maximal conservative treatment. Suction drain removal followed by daily needle aspiration however led to cessation of the fistula in all six cases. No patient required surgical re-exploration. Drain removal was associated with a significant fall in the volume of chylous output (p = 0.002). In selected cases of low output chylous fistula, suction drain removal and daily needle aspiration is an effective treatment option.

  20. Lung ultrasound-guided emergency pneumothorax needle aspiration in a very preterm infant.

    Science.gov (United States)

    Migliaro, Fiorella; Sodano, Angela; Capasso, Letizia; Raimondi, Francesco

    2014-12-14

    Pneumothorax is a frequent critical situation in the neonatal intensive care unit. Diagnosis relies on clinical judgement, transillumination and chest radiogram. We report the case of a very preterm infant suddenly developing significant and persistent desaturation and bradycardia. Re-intubation and cardiopulmonary resuscitation were performed. Clinical and cold light examination were not suggestive of pneumothorax according to two experienced neonatologists. A lung ultrasound scan showed evidence of right pneumothorax that was promptly aspirated. Approximately 20 min later, a chest radiogram confirmed the ultrasound diagnosis. Point-of-care lung ultrasound is a useful tool for detecting symptomatic pneumothorax and accelerating its treatment.

  1. Usefulness of Surgical Media Center as a Cataract Surgery Educational Tool

    Science.gov (United States)

    Ogawa, Tomoichiro; Shiba, Takuya; Tsuneoka, Hiroshi

    2016-01-01

    Purpose. This study retrospectively analyzed cataract surgeries to examine the usefulness of Surgical Media Center (SMC) (Abbott Medical Optics Inc.), a new cataract surgery recording device, for training of cataract surgery. Methods. We studied five hundred cataract surgeries conducted with a phacoemulsification system connected to the SMC. After surgery, the surgical procedures were reviewed, with changes in aspiration rate, vacuum level, and phaco power displayed as graphs superimposed on the surgical video. We examined whether use of SMC is able to demonstrate the differences in technique between experienced and trainee operators, to identify inappropriate phacoemulsification techniques from analyzing the graphs, and to elucidate the cause of intraoperative complications. Results. Significant differences in the time taken to reach maximum vacuum and the speed of increase in vacuum during irrigation and aspiration were observed between experienced and trainee operators. Analysis of the graphs displayed by SMC detected inappropriate phacoemulsification techniques mostly in cases operated by trainee operators. Conclusions. Using SMC, it was possible to capture details of cataract surgery objectively. This recording device allows surgeons to review cataract surgery techniques and identify the cause of intraoperative complication and is a useful education tool for cataract surgery. PMID:26881060

  2. Usefulness of Surgical Media Center as a Cataract Surgery Educational Tool

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    Tomoichiro Ogawa

    2016-01-01

    Full Text Available Purpose. This study retrospectively analyzed cataract surgeries to examine the usefulness of Surgical Media Center (SMC (Abbott Medical Optics Inc., a new cataract surgery recording device, for training of cataract surgery. Methods. We studied five hundred cataract surgeries conducted with a phacoemulsification system connected to the SMC. After surgery, the surgical procedures were reviewed, with changes in aspiration rate, vacuum level, and phaco power displayed as graphs superimposed on the surgical video. We examined whether use of SMC is able to demonstrate the differences in technique between experienced and trainee operators, to identify inappropriate phacoemulsification techniques from analyzing the graphs, and to elucidate the cause of intraoperative complications. Results. Significant differences in the time taken to reach maximum vacuum and the speed of increase in vacuum during irrigation and aspiration were observed between experienced and trainee operators. Analysis of the graphs displayed by SMC detected inappropriate phacoemulsification techniques mostly in cases operated by trainee operators. Conclusions. Using SMC, it was possible to capture details of cataract surgery objectively. This recording device allows surgeons to review cataract surgery techniques and identify the cause of intraoperative complication and is a useful education tool for cataract surgery.

  3. Surgical repair of a pseudoaneurysm of the ascending aorta after aortic valve replacement

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    Almeida Rui Manuel Sequeira de

    2001-01-01

    Full Text Available We report the case of a patient with a pseudoaneurysm of the ascending aortic clinically diagnosed 5 months after surgical replacement of the aortic valve. Diagnosis was confirmed with the aid of two-dimensional echocardiography and helicoidal angiotomography. The corrective surgery, which consisted of a reinforced suture of the communication with the ascending aorta after opening and aspiration of the cavity of the pseudoaneurysm, was successfully performed through a complete sternotomy using extracorporeal circulation, femorofemoral cannulation, and moderate hypothermia, with no aortic clamping.

  4. Different approaches to caudate lobectomy with "curettage and aspiration" technique using a special instrument PMOD: A Report of 76 cases

    Institute of Scientific and Technical Information of China (English)

    Shu-You Peng; Cheng-Hong Peng; Jiang-Tao Li; Yi-Ping Mou; Ying-Bin Liu; Yu-Lian Wu; He-Qing Fang; Li-Ping Cao; Li Chen; Xiu-Jun Cai

    2003-01-01

    AIM: To study different approaches to caudate lobectomy with "curettage and aspiration" technique using Peng's multifunctional operative dissector (PMOD). The surgical procedure of isolated complete caudate lobectomy was specially discussed.METHODS: In 76 cases of various types of caudate lobectomy, three approaches were used including left side approach, right side approach, and anterior approach.Among the 76 cases, isolated complete caudate lobectomy was carried out in 6 cases with transhepatic anterior approach. The surgical procedure consisted of mobilization of the total liver, ligation and separation of the short hepatic veins, splitting the liver parenchyma through the Cantlie's plane, ligation and division of the caudate portal triads from the hilum, dissection of the root of major hepatic veins,detachment of the caudate lobe from liver parenchyma.RESULTS: The mean operative time was 285±51 min,the mean blood loss was 1 600 mi. No severe complications were observed. Among the 6 cases receiving isolated complete caudate lobectomy with transhepatic anterior approach, one case died 17 months after operation due to disease recurrence and liver failure, the other 5 cases have been alive without recurrence, with one longest survival of 49 months.CONCLUSION: The choice of approach is essential to the success of caudate lobectomy. As PMOD and "curettage and aspiration" technique can delineate intrahepatic or extrahepatic vessels clearly, caudate lobe resection has become safer, easier and faster.

  5. Extracorporeal Membrane Oxygenation Therapy for Aspiration Pneumonia in a Patient following Left Pneumonectomy for Lung Cancer

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    Jangwhan Jo

    2016-05-01

    Full Text Available A patient had undergone left pneumonectomy for lung cancer and had an increased risk of fatal complications such as pneumonia, including acute respiratory distress syndrome (ARDS. The treatment effects of veno-venous extracorporeal membrane oxygenation (VV-ECMO for ARDS of postpneumonectomy patient are uncertain. A 74-year-old man with one lung experienced aspiration pneumonia while swallowing pills after the operation, and his condition progressed to ARDS within a day. He was successfully treated with VV-ECMO support and intensive care unit care.

  6. Primary lymphoma of the liver. Report of a case with diagnosis by fine needle aspiration.

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    Netto, D; Spielberger, R; Awasthi, S; Balaban, E P; Nowak, J A; Demian, S D

    1993-01-01

    In a 69-year-old man with hepatomegaly, a diagnosis of primary non-Hodgkin's lymphoma (NHL) of the liver was made by fine needle aspiration (FNA). At the time of presentation there was no evidence of involvement of the lymph nodes, bone marrow or any other organ. Although hepatic involvement is common in advanced stages of Hodgkin's disease and NHL, primary lymphoma of the liver is rare. The purpose of this paper is to report a rare occurrence of primary lymphoma of the liver and to demonstrate the possibility of making this diagnosis by FNA.

  7. A longitudinal study on boys' and girls' career aspirations and interest in technology

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    Ardies, Jan; De Maeyer, Sven; Gijbels, David

    2015-09-01

    Background: More young people, boys and girls, are needed in technical studies and professions, as the relative number of students in technology-related studies has been decreasing in most industrialised countries. To overcome this decrease several countries implemented mandatory technology classes in the curriculum of secondary education. Purpose: This study has two goals: exploring the evolution of pupils' interest during the year(s) they attend the mandatory technology classes and exploring determining characteristics for differences in boys' and girls' attitude change over time. Sample: This study focuses on data gathered in the first and second grade of the first cycle in general secondary education in the North region of Belgium, Flanders. In a first stage we selected a good representation of geographically spread schools (n = 20), from which over 1300 students participated. Design and methods: A longitudinal study with eight measurement occasions spread over the course of two years is presented in order to capture the evolution of students' attitudes, making use of a multilevel growth model analysis. Results: The results show that students' interest in technology decreases over time, although at the end of each grade interest is increasing again. Boys' and girls' interest in technology also evolves a little different in the first cycle of secondary education. For career aspirations we didn't see any significant difference between boys and girls. Boys' and girls' aspirations decrease over time with a little increase by the end of the second grade. Students with a more technological curriculum also have more career aspirations in the field of technology than their peers with other curricula. Although students' perceptions about technology as a subject for boys and girls are largely stable. Conclusions: The evolution of students' attitude is far from linear, this strengthens us in the choice for a more complex analysis model and the choice for more measuring

  8. Fine needle aspiration diagnosis of cryptococcal lymphadenitis: A window of opportunity

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    Suchitha S

    2008-01-01

    Full Text Available Cryptococcal meningitis is the most common, life-threatening, opportunistic, fungal disease in human immunodeficiency virus (HIV-infected individuals. An expeditious diagnosis is of utmost importance because once a cryptococcal infection disseminates, it becomes life-threatening. Pulmonary, intestinal, bone marrow, and retinal involvement have been described. There are very few reports, however, of lymphadenopathy along with cryptococcal meningitis. We report here a case of cryptococcal meningitis with lymphadenitis, which was diagnosed by fine needle aspiration cytology of the involved lymph nodes.

  9. Endoscopic ultrasound-guided fine needle aspiration: How to obtain a core biopsy?

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    Fuccio, Lorenzo; Larghi, Alberto

    2014-01-01

    Endoscopic ultrasound (EUS)-guided fine needle aspiration has emerged as the procedure of choice to obtain samples to reach a definitive diagnosis of lesions of the gastrointestinal tract and of adjacent organs. The obtainment of a tissue core biopsy presents several advantages that can substantially contribute to the widespread diffusion of EUS utilization in the community and in countries where cytology expertise may be difficult to be achieved. This article will review the EUS-guided fine needle biopsy techniques developed so far, the clinical results, their limitations as well as their future perspective. PMID:24955336

  10. A direct aspiration first pass technique for retrieval of a detached coil.

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    Masahira, Noritaka; Ohta, Tsuyoshi; Fukui, Naoki; Yanagawa, Toshio; Kondou, Yuichirou; Morimoto, Masanori; Ueba, Tetsuya

    2016-11-01

    A 64-year-old man was referred to our hospital for treatment of a cerebral aneurysm that was incidentally found. The aneurysm was 7 mm in size and located on the left anterior communicating artery. Using a balloon assisted technique, we performed coil embolization. During the second coil insertion, the first coil was dislodged into the anterior communicating artery. We attempted coil retrieval using a snare, which was unsuccessful. We applied a direct aspiration first pass technique (ADAPT) and advanced a Penumbra 4MAX immediately proximal to the dislodged coil; the dislodged coil was then successfully retrieved. ADAPT is a simple procedure for retrieval of a detached coil, and it can be used as an alternative to the snare technique.

  11. Rising Aspirations Dampen Satisfaction

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    Clark, Andrew E.; Kamesaka, Akiko; Tamura, Teruyuki

    2015-01-01

    It is commonly believed that education is a good thing for individuals. Yet, its correlation with subjective well-being is most often only weakly positive, or even negative, despite the many associated better individual-level outcomes. We here square the circle using novel Japanese data on happiness aspirations. If reported happiness comes from a…

  12. Rising Aspirations Dampen Satisfaction

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    Clark, Andrew E.; Kamesaka, Akiko; Tamura, Teruyuki

    2015-01-01

    It is commonly believed that education is a good thing for individuals. Yet, its correlation with subjective well-being is most often only weakly positive, or even negative, despite the many associated better individual-level outcomes. We here square the circle using novel Japanese data on happiness aspirations. If reported happiness comes from a…

  13. Paraganglioma with unusual presentation in parotid gland: A diagnostic dilemma in fine needle aspiration

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    Anagh A Vora

    2012-01-01

    Full Text Available Paragangliomas (PGLs are uncommon tumors. Although PGLs are known to occur in the head and neck region, especially the carotid body, middle ear, and larynx, involvement of the parotid glands has not been reported. In this article, we report the fine needle aspiration features of tumor in an unusual location, presenting as a parotid gland mass, submitted to pathology for initial diagnosis. The clinical presentation, cytomorphology, and the immunohistochemical features for the diagnosis are described. To our knowledge, this is the first case of paraganglioma of the parotid gland reported in the literature.

  14. Surgical treatment and histopathology of a symptomatic free-floating primary pigment epithelial iris cyst in the anterior vitreous

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    Eman Al-Kahtani

    2011-01-01

    Full Text Available We report the surgical removal of an iris pigment epithelial cyst that was floating freely in the posterior chamber of an 18-month-old child. The reason for surgical removal was disturbance in near vision secondary to the movement of the cyst across the visual axis. Visual disturbance secondary to a unilateral anterior vitreous iris cyst at this age is a rare presentation and, to the best of our knowledge, has not been reported previously as an indication for surgery. We performed histopathological study of the cyst aspirate to determine its contents and its possible origin.

  15. Infrared Thermal Imaging During Ultrasonic Aspiration of Bone

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    Cotter, D. J.; Woodworth, G.; Gupta, S. V.; Manandhar, P.; Schwartz, T. H.

    Ultrasonic surgical aspirator tips target removal of bone in approaches to tumors or aneurysms. Low profile angled tips provide increased visualization and safety in many high risk surgical situations that commonly were approached using a high speed rotary drill. Utilization of the ultrasonic aspirator for bone removal raised questions about relative amount of local and transmitted heat energy. In the sphenoid wing of a cadaver section, ultrasonic bone aspiration yielded lower thermal rise in precision bone removal than rotary mechanical drills, with maximum temperature of 31 °C versus 69 °C for fluted and 79 °C for diamond drill bits. Mean ultrasonic fragmentation power was about 8 Watts. Statistical studies using tenacious porcine cranium yielded mean power levels of about 4.5 Watts to 11 Watts and mean temperature of less than 41.1 °C. Excessively loading the tip yielded momentary higher power; however, mean thermal rise was less than 8 °C with bone removal starting at near body temperature of about 37 °C. Precision bone removal and thermal management were possible with conditions tested for ultrasonic bone aspiration.

  16. An evaluation of the diagnostic efficacy of fine needle aspiration biopsy in patients operated for a thyroid nodular goiter

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    Janczak D

    2016-09-01

    Full Text Available Dariusz Janczak,1,2 Wiktor Pawlowski,1 Tadeusz Dorobisz,1,3 Dawid Janczak,4 Karolina Dorobisz,5 Michal Lesniak,1 Agnieszka Ziomek,1 Mariusz Chabowski1,2 1Department of Surgery, 4th Military Teaching Hospital, 2Department of Clinical Nursing, Division of Nursing in Surgical Procedures, 3Department of Clinical Basics of Physiotherapy, 4Department of Palliative Care Nursing, Faculty of Health Science, 5Department of Otolaryngology, Head and Neck Surgery, Wroclaw Medical University, Wroclaw, Poland Background: Thyroid cancer (TC comprises 1% of all carcinomas and is the most common malignancy of the endocrine system. The disease is more common in women, with its peak morbidity observed in 40–50-year-old patients. The main risk factors include radiation, iodine deficiency, hereditary background, and genetic mutations. Among all diagnosed thyroid nodules, 5%–30% will evolve into cancer. The gold-standard procedure in the preoperative evaluation of a nodular goiter, apart from ultrasonography, is fine needle aspiration (FNA biopsy. The FNA biopsy is favored for its simplicity, safety, and high specificity and sensitivity rates. Aim: The aim of our study was to evaluate the clinical efficacy of FNA based on the patients’ register. Materials and methods: In the Department of Surgery at the 4th Military Teaching Hospital in Wroclaw, 2,133 patients underwent thyroid surgery for thyroid goiter between 1996 and 2015. One hundred and eight cases of TC were diagnosed and of these, 66 patients had a preoperative FNA. Results: Fourteen FNA biopsies (21% revealed cancer, all of which were confirmed in the postoperative histopathology, although six cases of FNA-diagnosed cancer revealed a different histological type postoperatively. Eighteen FNA biopsies (27% were suspected of being malignant. A disturbingly high rate of “benign” FNA biopsies (32 cases; 48% revealed TC after surgery. Conclusion: It is of great importance that the quality and quantity of

  17. Fine-needle aspiration cytology diagnosis of metastatic nonhaematological neoplasms of the breast: a series of seven cases.

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    Rodríguez-Gil, Yolanda; Pérez-Barrios, Andrés; Alberti-Masgrau, Nuria; Garzón, Alfredo; de Agustín, Pedro

    2012-04-01

    Metastatic neoplasms of the breast are rare. Mammary metastases as the initial presentation are even more infrequent and can simulate a primary malignancy clinically and radiologically. Recognition of metastatic tumors in the breast is important because it would prevent unnecessary mutilating surgery and would lead to appropriate treatment of the primary tumor. There is a broad variety of cytological appearances reported about primary tumors and few reports about secondary breast malignancies, specially diagnosed by FNAC. This study was carried out to examine the clinical and cytomorphologic features of metastatic breast tumors found in 12 de Octubre University Hospital during a period of 20 years. It confirms the utility of FNAC and describes findings that can help in the differential diagnosis that sometimes can be very difficult. Seven cases of nonhematological metastatic neoplasms of the breast were identified from the files of the Department of Pathology of the 12 de Octubre University Hospital from a total of 64,000 aspirates. We included only metastatic tumors from extramammary nonhematological neoplasms. There were nine cases of hematological metastatic neoplasm that were excluded. They were diagnosed with FNAC and confirmed by histopathology, with at least three years of follow up. The breast lump was the first manifestation of malignancy in one case of synovial sarcoma. The other six cases had been previously diagnosed of cancer. These included one malignant melanoma, one alveolar rhabdomyosarcoma, one mixed müllerian tumor, one medullary carcinoma of thyroid, one colonic adenocarcinoma, and one gastric adenocarcinoma. The period of time between primary tumor and metastases ranged from one month to eight years. An accurate cytologic diagnosis was made in all the cases. Immunocytochemistry was available but diagnosis could be made with cytomorphology alone in the seven cases. Fine-needle aspiration cytology is an excellent first line diagnostic modality

  18. The Role of School Performance in Narrowing Gender Gaps in the Formation of STEM Aspirations: A Cross-National Study

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    Allison eMann

    2015-02-01

    Full Text Available Abstract This study uses cross-national evidence to estimate the effect of school peer performance on the size of the gender gap in the formation of STEM career aspirations. We argue that STEM aspirations are influenced not only by gender stereotyping in the national culture but also by the performance of peers in the local school environment. Our analyses are based on the Program for International Student Assessment (PISA. They investigate whether 15-year-old students from 55 different countries expect to have STEM jobs at the age of 30. We find considerable gender differences in the plans to pursue careers in STEM occupations in all countries. Using PISA test scores in math and science aggregated at the school level as a measure of school performance, we find that stronger performance environments have a negative impact on student career aspirations in STEM. Although girls are less likely than boys to aspire to STEM occupations, even when they have comparable abilities, boys respond more than girls to competitive school performance environments. As a consequence, the aspirations gender gap narrows for high-performing students in stronger performance environments. We show that those effects are larger in countries that do not sort students into different educational tracks.

  19. The role of school performance in narrowing gender gaps in the formation of STEM aspirations: a cross-national study.

    Science.gov (United States)

    Mann, Allison; Legewie, Joscha; DiPrete, Thomas A

    2015-01-01

    This study uses cross-national evidence to estimate the effect of school peer performance on the size of the gender gap in the formation of STEM career aspirations. We argue that STEM aspirations are influenced not only by gender stereotyping in the national culture but also by the performance of peers in the local school environment. Our analyses are based on the Program for International Student Assessment (PISA). They investigate whether 15-year-old students from 55 different countries expect to have STEM jobs at the age of 30. We find considerable gender differences in the plans to pursue careers in STEM occupations in all countries. Using PISA test scores in math and science aggregated at the school level as a measure of school performance, we find that stronger performance environments have a negative impact on student career aspirations in STEM. Although girls are less likely than boys to aspire to STEM occupations, even when they have comparable abilities, boys respond more than girls to competitive school performance environments. As a consequence, the aspirations gender gap narrows for high-performing students in stronger performance environments. We show that those effects are larger in countries that do not sort students into different educational tracks.

  20. Fine needle aspiration cytology of supraclavicular lymph nodes: Our experience over a three-year period.

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    Mitra, Sumit; Ray, Suchandra; Mitra, Pradip K

    2011-07-01

    This study was taken up with the aim to investigate the pattern of supraclavicular lymphadenopathy among patients presenting to our tertiary care institution, evaluate the diagnostic efficacy of fine needle aspiration cytology (FNAC), and analyze the diagnostic pitfalls. A total of 215 patients were subjected to FNAC of supraclavicular lymph nodes over a three-year period (August 2006 to July 2009). Since in 18 patients as either the aspirate was inadequate or the opinion was equivocal, we analyzed the remaining 197 cases. Malignant pathology accounted for 79.7% (157/197) of the cases. These were mostly cases of metastatic squamous cell carcinoma (79/197, 40.1%), adenocarcinoma (47/197, 23.9%), small cell carcinoma (12/197, 6.1%) and lymphoma (10/197, 5%). There were 28 (14.2%) cases of tuberculosis. Out of these 197 patients, 92 patients were biopsied. The opinion based on FNAC was erroneous in 6 cases but corroborated with the final histopathology findings in the remaining 86 cases. FNAC is an excellent first line of investigation; and when used with a proper combination of experience and diligence, it can greatly reduce the number of errors.

  1. Adjunctive manual thrombus aspiration during ST-segment elevation myocardial infarction: a meta-analysis of randomized controlled trials.

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    Song-Bai Deng

    Full Text Available The aim of this study was to synthesize evidence by examining the effects of manual thrombus aspiration on clinical outcomes in patients with ST-segment elevation myocardial infarction (STEMI.A total of 26 randomized controlled trials (RCTs, enrolling 11,780 patients, with 5,869 patients randomized to manual thrombus aspiration and 5,911 patients randomized to conventional percutaneous coronary intervention (PCI, were included in the meta-analysis. Separate clinical outcome analyses were based on different follow-up periods. There were no statistically reductions in the incidences of mortality (risk ratio [RR], 0.86 [95% confidence interval [CI]: 0.73 to 1.02], reinfarction (RR, 0.62 [CI, 0.31 to 1.32] or target vessel revascularization (RR, 0.89 [CI, 0.75 to 1.05] in the manual thrombus aspiration arm at 12 to 24 months of follow-up. The composite major adverse cardiac events (MACEs outcomes were significantly lower in the manual thrombus aspiration arm over the long-term follow-up (RR, 0.76 [CI, 0.63 to 0.91]. A lower incidence of reinfarction was observed in the hospital to 30 days (RR, 0.59 [CI, 0.37 to 0.92].The present meta-analysis suggested that there was no evidence that using manual thrombus aspiration in patients with STEMI could provide distinct benefits in long-term clinical outcomes.

  2. A new technique for the diagnosis of mycetoma using fixed blocks of aspirated material.

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    Yousif, B M; Fahal, A H; Shakir, M Y

    2010-01-01

    The aim of this prospective study was to evaluate the use of the cell block technique as a safe, accurate and quick tool for the cytodiagnosis of mycetoma. The study included 240 patients with suspected mycetoma. The suspected lesion was aspirated and the aspirated material was processed to form cell blocks. The cell blocks were processed as described for routine tissue histopathological examination. Haematoxylin/eosin-stained sections were reviewed to identify the morphological features of the mycetoma grains and the different inflammatory tissue reactions. The findings were compared with those seen in histopathological sections. The different mycetoma grains showed distinct morphological features on the cell block that were identical to those seen in histopathological sections. Distinction between eumycetoma and actinomycetoma and their classification according to the causative agent were possible. The cell block technique had sensitivities of 87.5% and 85.7% for eumycetoma and actinomycetoma, respectively, and there were no statistical differences in the findings obtained by the cell block and histopathological techniques. The technique is simple, rapid, specific, sensitive and inexpensive. It can be used in the routine diagnosis of mycetoma and to obtain grains for culture identification. The cell blocks can be preserved for a long period for future studies.

  3. Wet voice as a sign of penetration/aspiration in Parkinson's disease: does testing material matter?

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    Sampaio, Marília; Argolo, Natalie; Melo, Ailton; Nóbrega, Ana Caline

    2014-10-01

    Wet voice is a perceptual vocal quality that is commonly used as an indicator of penetration and/or aspiration in clinical swallowing assessments and bedside screening tests. Our aim was to describe the clinimetric characteristics of this clinical sign using various fluid materials and one solid food in the Parkinson's disease (PD) population. Consecutive PD individuals were submitted for simultaneous fiberoptic endoscopic evaluation of swallowing (FEES) and voice recording. Speech therapists rated the presence or absence of wetness and other voice abnormalities. Two binary endpoints of FEES were selected for comparison with an index test: low penetration (LP) and low penetration and/or aspiration (LP/ASP). The accuracy of wet voice changed according to the testing material in PD patients. Overall, the specificity of this indicator was better than its sensitivity, and the wafer cookie and yogurt drink yielded the best indices. Our data show that wet voice is clearly indicative of LP or LP/ASP in PD patients in case of positive test. However, in the case of a negative result, the wet voice test should be repeated or combined with other clinical tests to include or exclude the risk of LP or LP/ASP.

  4. Thyroid fine-needle aspiration biopsy and thyroid cancer diagnosis: a nationwide population-based study.

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    Li-Ying Huang

    Full Text Available Thyroid cancer is the most common endocrine gland malignancy and fine-needle aspiration biopsy is widely used for thyroid nodule evaluation. Repeated aspiration biopsies are needed due to plausible false-negative results. This study aimed to investigate the overall relationship between aspiration biopsy and thyroid cancer diagnosis, and to explore factors related to shorter diagnostic time.This nationwide retrospective cohort study retrieved data from the Longitudinal Health Insurance Database in Taiwan. Subjects without known thyroid malignancies and who received the first thyroid aspiration biopsy after 2004 were followed-up from 2004 to 2009 (n = 7700. Chi-square test, Kaplan-Meier survival analysis, and Cox proportional hazards model were used for data analysis.Of 7700 newly-aspirated patients, 276 eventually developed thyroid cancer (malignancy rate 3.6%. Among the 276 patients with thyroid cancer, 61.6% underwent only one aspiration biopsy and 81.2% were found within the first year after the initial aspiration. Cox proportional hazards model revealed that aspiration frequency (HR 1.07, 95% CI 1.06-1.08, ultrasound frequency (HR 1.02, 95% CI 1.01-1.03, older age, male sex, and aspiration biopsies arranged by surgery, endocrinology or otolaryngology subspecialties were all associated with shorter time to thyroid cancer diagnosis.About 17.4% of thyroid cancer cases received more than two aspiration biopsies and 18.8% were diagnosed one year after the first biopsy. Regular follow-up with repeated aspiration or ultrasound may be required for patients with clinically significant thyroid nodules.

  5. Fine-needle aspiration cytology as a diagnostic modality for cysticercosis: A clinicocytological study of 137 cases

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    Pooja Kala

    2014-01-01

    Conclusion: Fine-needle aspiration cytology in cysticercosis is a low-cost outpatient procedure. The cytological diagnosis is quite straightforward in cases where the actual parasite structures are identified in the smears. In other cases, a cytological diagnosis of suspicious of cysticercosis can be given if the cytological findings suggest the same.

  6. Fine Needle Aspiration of Thyroid Nodules Using the Bethesda System for Reporting Thyroid Cytopathology: An Institutional Experience in a Rural Setting

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    Kaminoh, Yuuki; Forward, Terra; Schwartz, Frank L.; Jenkinson, Scott

    2017-01-01

    Background. Fine needle aspiration (FNA) remains the first-line diagnostic in management of thyroid nodules and reduces unnecessary surgeries. However, it is still challenging since cytological results are not always straightforward. This study aimed to examine the results of thyroid FNA using the Bethesda system for reporting thyroid cytopathology (TBSRTC) to establish the level of accuracy of FNA procedures in a rural practice setting. Method. A retrospective chart review was conducted on existing thyroid FNA performed in a referral endocrine center between December 2011 and November 2015. Results. A total of 159 patients (18–88 years old) and 236 nodule aspirations were performed and submitted for evaluation. 79% were benign, 3% atypia/follicular lesion of unknown significance (AUS/FLUS), 5% follicular neoplasm/suspicious for follicular neoplasm (FN/SFN), 4% suspicious for malignancy (one case was indeed an atypical parathyroid neoplasm by surgical pathology), 2% malignant, and 7% nondiagnostic. Two cases also had advanced molecular analysis on FNA specimens before thyroidectomy. Conclusion. The diagnostic yield of FNA cytology from our practice in a rural setting suggests that accuracy and specificity are comparable to results from larger centers. PMID:28280507

  7. A Case with Foreign Body Aspiration who Developed Cushingoid Appearance due to Corticosteroids Given for Misdiagnosis of Asthma: Case Report

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    Ayfer İnal

    2008-01-01

    Full Text Available Foreign body aspiration is a common problem in childhood which can result in complications with high morbidity and mortality. It may be misdiagnosed because of symptoms such as cough, wheezing or stridor which may also be seen in other disorders. Although it is the most helpful tool in diagnosis, absence of typical history and inadequate clinical and radiologic findings may lead to delayed diagnosis in some cases. These cases show high risk for complications and therefore early diagnosis is important. Prolonged or recurrent respiratory symptoms should alert the physician for foreign body aspiration and it should be particularly interrogated. We present a case of foreign body aspiration in a 10-year-old boy who had been misdiagnosed as asthma and developed cushingoid appearance due to high dose corticosterioids. (Journal of Current Pediatrics 2008; 6: 124-6

  8. Maxillary Sinus Augmentation Combining Bio-Oss with the Bone Marrow Aspirate Concentrate: A Histomorphometric Study in Humans

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    Paulo José Pasquali

    2015-01-01

    Full Text Available Purpose. To investigate the regenerative results obtained with the association of bone marrow aspirate concentrate using the Bone Marrow Aspirate Concentrate (BMAC method to a xenogeneic bone graft (Bio-Oss in sinus floor elevation. Materials and Methods. Using a randomized controlled study design in eight consecutive patients (age of 55.4 ± 9.2 years, 16 sinus floor lift procedures were performed with Bio-Oss alone (control group, CG, n=8 or combined with bone marrow aspirate concentrate obtained via the BMAC method (test group, TG, n=8. Six months after the grafting procedures, bone biopsies were harvested during implant placement and were analyzed by histomorphometry. Results. Histomorphometric analysis revealed a significantly higher amount (p0.05 of nonmineralized tissue (38.53 ± 13.08% and 49.90 ± 7.64%, resp.. Conclusion. The use of bone marrow concentrate obtained by BMAC method increased bone formation in sinus lift procedures.

  9. Maxillary Sinus Augmentation Combining Bio-Oss with the Bone Marrow Aspirate Concentrate: A Histomorphometric Study in Humans

    Science.gov (United States)

    Pasquali, Paulo José; Teixeira, Marcelo Lucchesi; de Oliveira, Thiago Altro; de Macedo, Luis Guilherme Scavone; Aloise, Antonio Carlos; Pelegrine, André Antonio

    2015-01-01

    Purpose. To investigate the regenerative results obtained with the association of bone marrow aspirate concentrate using the Bone Marrow Aspirate Concentrate (BMAC) method to a xenogeneic bone graft (Bio-Oss) in sinus floor elevation. Materials and Methods. Using a randomized controlled study design in eight consecutive patients (age of 55.4 ± 9.2 years), 16 sinus floor lift procedures were performed with Bio-Oss alone (control group, CG, n = 8) or combined with bone marrow aspirate concentrate obtained via the BMAC method (test group, TG, n = 8). Six months after the grafting procedures, bone biopsies were harvested during implant placement and were analyzed by histomorphometry. Results. Histomorphometric analysis revealed a significantly higher amount (p 0.05) of nonmineralized tissue (38.53 ± 13.08% and 49.90 ± 7.64%, resp.). Conclusion. The use of bone marrow concentrate obtained by BMAC method increased bone formation in sinus lift procedures. PMID:26543482

  10. Parents Influencing Secondary Students' University Aspirations: A Multilevel Approach Using School-SES

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    Watson, Stuart; Vernon, Lynette; Seddon, Sarah; Andrews, Yolanda; Wang, Angela

    2016-01-01

    Students' university aspirational capacity and expectancies are key factors in predicting future university participation. Aspirations and expectations to attend university are strongly influenced by parent educational socialisation and school culture. This study investigates associations between students' university discussions with parents and…

  11. Oral health care and aspiration pneumonia in frail older people: a systematic literature review

    NARCIS (Netherlands)

    Maarel-Wierink, C.D. van der; Vanobbergen, J.N.; Bronkhorst, E.M.; Schols, J.M.; Baat, C. de

    2013-01-01

    OBJECTIVE: To systematically review the literature on oral health care interventions in frail older people and the effect on the incidence of aspiration pneumonia. BACKGROUND: Oral health care seems to play an important role in the prevention of aspiration pneumonia in frail older people. METHODS: P

  12. Cyto-morphological features of extramedullary acute megakaryoblastic leukemia on fine needle aspiration and cerebrospinal fluid cytology: A case report

    Directory of Open Access Journals (Sweden)

    Sanjeev Chitragar

    2011-01-01

    Full Text Available Extramedullary deposits may be the presenting feature of acute myeloid leukemia. An early and accurate diagnosis on cytology will aid in correct patient management. This is especially true for patients with acute megakaryoblastic leukemia (AML M7, where bone marrow aspiration may yield only a dry tap. While cytomorphological features of myeloid sarcoma of other types are well recognized due to its rarity, there are only two case reports discussing the morphological details of megakaryoblastic differentiation on aspiration cytology. We present the case of a 25-year-old patient with extramedullary involvement of lymph node and cerebrospinal fluid by AML M7, describing in detail, the morphological features on aspiration as well as exfoliative cytology.

  13. A social work study on relationship between parenting styles and career aspirations as well as psychological well-being

    Directory of Open Access Journals (Sweden)

    Atefeh Arab

    2013-07-01

    Full Text Available We present a social work study on relationship between parenting styles and career aspirations as well as psychological well-being among third year high school female students in city of Khomeinishahr, Iran during the year of 2012. The study selects a sample of 300 students from 1260 female students who were enrolled in third year high school education, randomly. The study uses the Baumrind’s questionnaire on parenting style, which consists of 30 questions which equally measure three parenting styles including authoritarian, indulgent and authoritative in Likert scale. The survey also uses Gottfredson’s questionnaire to examine occupational aspirations. The study examines whether there is any relationship between parenting style from one side and three personal characteristics including gender, career aspiration and wishes type on the other side. Using Chi-Square technique, the survey examines three hypotheses and the results confirm all three hypotheses of the survey.

  14. A clarity clinic for surgical writing.

    Science.gov (United States)

    Derish, Pamela; Eastwood, Susan

    2008-06-01

    Although writing and publishing are key to career development and academic success for surgeons, learning the skills needed to write publishable research reports is an often neglected aspect of surgical training. This report distills several lessons from scientific writing courses for surgeons taught at the University of California, San Francisco, to give a wider audience of academic surgeons tools they can use to write scientific prose more clearly. Drawing extensively on real examples of surgical writing, we cover techniques that are indispensable for achieving clarity, including choosing words carefully, designing well-constructed sentences, building structured paragraphs, and displaying your thinking clearly by using topic sentences and transitions.

  15. Surgical management of moyamoya disease: a review.

    Science.gov (United States)

    Baaj, Ali A; Agazzi, Siviero; Sayed, Zafar A; Toledo, Maria; Spetzler, Robert F; van Loveren, Harry

    2009-04-01

    Moyamoya disease (MMD) is a progressive, occlusive disease of the distal internal carotid arteries associated with secondary stenosis of the circle of Willis. Symptoms include ischemic infarcts in children and hemorrhages in adults. Bypass of the stenotic vessel(s) is the primary surgical treatment modality for MMD. Superficial temporal artery-to-middle cerebral artery bypass is the most common direct bypass method. Indirect techniques rely on the approximation of vascularized tissue to the cerebral cortex to promote neoangiogenesis. This tissue may be in the form of muscle, pericranium, dura, or even omentum. This review highlights the surgical options available for the treatment of MMD.

  16. Aspiration pneumonia of mineral oil: a case report; Pneumonia por aspiracao de oleo mineral: relato de um caso

    Energy Technology Data Exchange (ETDEWEB)

    Malheiros, Noemia Reis; Costa Praxedes, Marcia da; Machado, Dianne Mello; Marchiori, Edson [Universidade Federal Fluminense, Niteroi, RJ (Brazil). Hospital Universitario Antonio Pedro. Dept. de Radiologia; Morandi, Jose Laerte J.B. [Universidade Federal Fluminense, Niteroi, RJ (Brazil). Hospital Universitario Antonio Pedro. Dept. Materno-Infantil; Teixeira, Graca Helena M.C. [Universidade Federal Fluminense, Niteroi, RJ (Brazil)

    1995-07-01

    The authors report a case of 14 month-old boy with clinical features of dyspnea, cough and acrocyanosis following aspiration of mineral oil used in the treatment of partial small bowel obstruction by Ascaris lumbricoides. A chest roentgenogram was reported as extensive bilateral confluent consolidation that showed progressive improvement and the presence of a bilateral infiltration. The diagnosis of aspiration pneumonia of mineral oil was confirmed by lung biopsy. Radiological and anatomo pathological aspects are presented as well as a review of the medical literature about the case. (author). 6 refs., 3 figs.

  17. Diagnostic accuracy of fine needle aspiration cytology in providing a diagnosis of cervical lymphadenopathy among HIV-infected patients.

    Science.gov (United States)

    Muyanja, David; Kalyesubula, Robert; Namukwaya, Elizabeth; Othieno, Emmanuel; Mayanja-Kizza, Harriet

    2015-03-01

    Opportunistic infections and malignancies cause lymphadenopathy in HIV-infected patients. The use and accuracy of fine needle aspiration cytology in diagnosing of cervical lymphadenopathy among HIV-infected patients is not well studied in Uganda. The aim of this study was to determine the diagnostic accuracy of fine needle aspiration cytology in providing a diagnosis of cervical lymphadenopathy among HIV-infected patients in Uganda. We consecutively recruited adult HIV-infected patients with cervical lymphadenopathy admitted to Mulago Hospital medical wards. Clinical examination, fine needle aspiration and lymph node biopsy were performed. We estimated the sensitivity, specificity; negative and positive predictive values using histology as the gold standard. We enrolled 108 patients with a mean age of 33 years (range, 18-60), 59% were men and mean CD4 was 83(range, 22-375) cells/mm(3). The major causes of cervical lymphadenopathy were: tuberculosis (69.4%), Kaposi's sarcoma-KS (10.2%) and reactive adenitis (7.4%). Overall fine needle aspiration cytology accurately predicted the histological findings in 65 out of 73 cases (89%) and missed 7 cases (9.5%). With a sensitivity of 93.1%, specificity of 100%, positive predictive value of 100% and negative predictive value of 78.7% for tuberculosis and 80%; 98.4%;88.9% and 98.9% for KS respectively. No fine needle aspiration complications were noted. Fine needle aspiration cytology is safe and accurate in the diagnosis of tuberculosis and KS cervical lymphadenopathy among HIV-positive patients.

  18. "Everybody Gotta Have a Dream": Rap-centered Aspirations among Young Black Males Involved in Rap Music Production - A Qualitative Study.

    Science.gov (United States)

    Foster, B Brian

    Youth express diverse desires for their educational and occupational futures. Sometimes these aspirations are directed towards somewhat unconventional careers such as rapping and other types of involvement in rap music production. Although many studies have examined traditional educational and occupational aspirations, less is known about the factors that give rise to rap-centered aspirations and how individuals pursue them, particularly as they transition to early adulthood. Drawing on 54 semi- and unstructured interviews with 29 black young men involved in rap music production, I find that rap-centered aspirations are shaped by a range of factors, most notably feedback regarding one's rap skills, access to recording and production equipment, and the financial means to maintain involvement in rap music production while also ensuring personal and family economic stability. The young men in the study attached different meanings to their aspirations and sometimes recast their motivations for participating in rap music production in response to various social and economic factors.

  19. A STUDY OF HISTOPATHOLOGICAL CORRELATION WITH FINE NEEDLE ASPIRATION CYTOLOGY OF CERVICAL LYMPHADENOPATHY

    Directory of Open Access Journals (Sweden)

    Bobby Duarah

    2016-07-01

    Full Text Available BACKGROUND Cervical lymphadenopathy is a common manifestation in our country where incidence of tuberculosis and oral cancer is fairly high, so the proper and early diagnosis of lymphadenopathy is very important for early and effective treatment. AIM The present study was undertaken in the Department of Pathology, Assam Medical College and Hospital, for a period of one year with a view to correlate the cytological diagnosis with histopathology. MATERIALS AND METHODS A series of 100 cases with clinical presentation of palpable lymph node at any part of the cervical region irrespective of age and sex attending the different OPDs of this institution were taken. FNAC was done as an initial step for diagnosis. The results were confirmed by incisional/excisional biopsy afterwards. RESULT Out of 100 cases, there were 74 cases of benign lesions (74% and 26 cases of malignant lesions (26% proven histopathologically. The peak incidence of age group suffering from the disease was 21-30 years (25% followed by 11-20 years (24%. Majority were Tubercular (40% followed by Inflammatory (34%, Metastasis (16%, and Lymphoma (10%. All the cases (Benign and Malignant presented with neck swelling (100%. It was seen that the Jugulodigastric, Posterior triangle, and the submandibular groups of lymph nodes were the most commonly involved groups with a percentage being 41%, 21%, and 13% respectively. Out of a total of 74 histologically proved benign cases, cytology could diagnose 73 cases (98.7%. The percentage of accuracy was 98.7%. Also, the cytological diagnosis could be obtained in 24 out of 26 cases with malignant lesions when correlated with histopathology. The percentage of accuracy was 92.3%. It was seen that the overall accuracy rate of aspiration cytology in the diagnosis of benign lesions was 98.7% and that of malignant lesions was 92.3% against 100% accuracy with histopathology. The overall accuracy of aspiration cytology is 97%. CONCLUSION Though

  20. CSR as Aspirational Talk

    DEFF Research Database (Denmark)

    Christensen, Lars Thøger; Morsing, Mette; Thyssen, Ole

    2013-01-01

    Most writings on corporate social responsibility (CSR) treat lack of consistency between organizational CSR talk and action as a serious problem that needs to be eliminated. In this article, we argue that differences between words and action are not necessarily a bad thing and that such discrepan......Most writings on corporate social responsibility (CSR) treat lack of consistency between organizational CSR talk and action as a serious problem that needs to be eliminated. In this article, we argue that differences between words and action are not necessarily a bad thing...... and that such discrepancies have the potential to stimulate CSR improvements. We draw on a research tradition that regards communication as performative to challenge the conventional assumption that CSR communication is essentially superficial, as opposed to CSR action. In addition, we extend notions of organizational...... hypocrisy to argue that aspirational CSR talk may be an important resource for social change, even when organizations do not fully live up to their aspirations....

  1. Candida Albicans Infection Masquerading as a Soft Tissue Tumour Diagnosed by Fine Needle Aspiration Cytology

    Science.gov (United States)

    Govind, Abhishek Mandya; Pechiat, Tony; Manchaih, Sanjay; Shankar, Shivshankar Vijay

    2017-01-01

    A 60-year-old male, diabetic presented with a soft tissue mass over the right forearm of 15 days duration. The swelling was 5 x 3 cm and a clinical diagnosis of neurofibroma was made. Fine Needle Aspiration Cytology (FNAC) was done using standard technique. Smears showed predominantly suppurative inflammation, foreign body giant cells, granulomas and fungal hyphae. KOH mount, culture and germ tube test was positive. Final diagnosis of fungal granuloma was made. Fungal infections should be included in the differential diagnosis of a soft tissue mass lesion. All soft tissue suppurative inflammatory lesions should be diligently screened to look for pathogens if any. Diagnostics in medicine have taken a major leap with advent of molecular technologies. Despite this, simple old traditional methods like FNAC supplemented by other basic laboratory techniques like KOH mount and culture still form the cream of a diagnostic laboratory and can come as a savior for the pathologist, the clinicians and the patients.

  2. Dermatologic Surgical Instruments: A History and Review.

    Science.gov (United States)

    Gandhi, Sumul A; Kampp, Jeremy T

    2017-01-01

    Dermatologic surgery requires precision and accuracy given the delicate nature of procedures performed. The use of the most appropriate instrument for each action helps optimize both functionality and cosmetic outcome. To review the history of surgical instruments used in dermatology, with a focus on mechanism and evolution to the instruments that are used in current practice. A comprehensive literature search was conducted via textbook and journal research for historic references while review of current references was conducted online using multiple search engines and PubMed. There are a number of articles that review instruments in dermatology, but this article adds a unique perspective in classifying their evolution, while also presenting them as levers that serve to increase human dexterity during the course of surgery. Surgical instruments allow fine manipulation of tissue, which in turn produces optimal outcomes. Surgical tools have been around since the dawn of man, and their evolution parallels the extent to which human civilization has specialized over time. This article describes the evolution of instruments from the general surgical armamentaria to the specialized tools that are used today.

  3. Complications of first-trimester abortion by vacuum aspiration after cervical preparation with and without misoprostol: a multicentre randomised trial.

    Science.gov (United States)

    Meirik, Olav; My Huong, Nguyen Thi; Piaggio, Gilda; Bergel, Eduardo; von Hertzen, Helena

    2012-05-12

    Little information is available about the incidence of complications from vacuum aspiration for first-trimester abortion after cervical preparation with prostaglandin analogues. We compared incidence of complications from vacuum aspiration in women who had had cervical preparation with misoprostol and those who had not. We did a randomised parallel-group trial at 14 centres in nine countries between Oct 22, 2002, and Sept 24, 2005. Healthy women seeking first-trimester abortion were randomly assigned via a computer-generated randomisation sequence stratified by centre, to receive vaginal administration of either two 200 μg tablets of misoprostol or two placebo tablets 3 h before abortion by vacuum aspiration. Participants and health-care personnel other than staff administering the treatment were masked to group assignment. Follow-up was up to 2 weeks. The primary outcome was one or more complications of vacuum aspiration (cervical tear, uterine perforation, incomplete abortion, uterine re-evacuation, pelvic inflammatory disease, or any other serious adverse event). We included women undergoing treatment and vacuum aspiration in the analysis of immediate complications; whereas, in the analysis of delayed complications, we included only those followed-up. In the analysis of any immediate or delayed complication, we excluded women lost to follow-up. This trial is registered, number ISRCTN85366519. We randomly assigned 2485 women to the misoprostol group and 2487 to the placebo group. Two women in the misoprostol group did not have vacuum aspiration. 56 women in each group were lost to follow-up. 50 (2%) of 2427 women in the misoprostol group and 74 (3%) of 2431 in the placebo group had one or more complication of vacuum aspiration (relative risk [RR] 0·68, 95% CI 0·47-0·96). No women in the misoprostol group had cervical tears and three had uterine perforations compared with two women in the placebo group who had cervical tears and one who had perforation. 19

  4. Fine-needle aspiration cytology of subcutaneous cysticercosis: A series of five cases

    Directory of Open Access Journals (Sweden)

    Kusum D Jashnani

    2016-01-01

    Full Text Available Taenia solium, a potentially dangerous parasite, causes human cysticercosis that can cause a gamut of manifestations affecting the various systems of the body. Sometimes, parasitic infestations present as only superficial palpable subcutaneous or intramuscular nodules that are usually mistaken for lymph nodes or benign tumors like lipoma, neurofibroma, or epidermal inclusion cysts. Fine-needle aspiration cytology (FNAC has emerged as a useful tool in the diagnosis of these superficial parasitic lesions. It also helps in avoiding unnecessary open biopsy to obtain a diagnosis. We, herein, report a series of five cases of subcutaneous cysticercosis at different sites (axilla, chest wall, abdominal wall, lateral neck, and cheek misdiagnosed as lipomas and lymph nodes and finally diagnosed on FNAC.

  5. Assessment of the role of a student-led surgical interest group in surgical education.

    Science.gov (United States)

    Li, Ran; Buxey, Kenneth; Ashrafi, Akbar; Drummond, Katharine J

    2013-01-01

    We describe the development of a medical student surgical interest group, its initial evaluation, and future plans. The Surgical Students Society of Melbourne was formed in August 2008 by a group of senior medical students from the University of Melbourne. The Surgical Students Society of Melbourne seeks to provide additional surgical teaching and professional development for students interested in a career in surgery. It also aims to provide junior doctors with leadership and teaching opportunities to meet the requirements of the Royal Australasian College of Surgeons for application to the Surgical Education and Training program. Its program also addresses contemporary workforce issues, such as women in surgery and rural surgery. The society runs a weekly teaching program during the semester and procedural and careers workshops throughout the year. A survey of students attending the teaching program was conducted by means of written and online questionnaires. The results suggest that the society has been successful in augmenting surgical education and providing opportunities to improve procedural skills, but also highlighted areas of the program that may be improved, including aspects of surgical professional development and role modeling. The Surgical Students Society initiative was generally very well received by students and shows great potential as a means for augmenting surgical education at the medical student level. Copyright © 2012 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

  6. A new surgical technique for ingrown toenail.

    Science.gov (United States)

    Mousavi, Seyed Reza; Khoshnevice, Jaledin

    2012-01-01

    Background. Ingrowing toenails are a common condition which, when recurrent and painful, are often treated surgically. The aim of this study is to present a new simple surgical technique for ingrown toenails with good results. Method and Patients. The selected 250 patients with affected toes were surgically treated by our technique and observed from 1998 to 2004. Marginal nail elevation combined with surgical excision of the granulation tissue was more successful. For fixing the nail margin on the toe we have done one-bite suture by Nylon 3/0 that was removed after 3 weeks. Results. All patients were operated on by our new technique and the outcome was excellent; recurrence and failure of the technique were very low. Discussion. Because with this simple technique we excise the granulation tissue and elevate margin of nail over the skin, we will have higher cure rate, shorter postoperative pain, lower risk of postoperative infection, and remarkable cosmetic result without deformity; hence this technique should be considered as an alternative method of treatment.

  7. Pituitary carcinoma diagnosed on fine needle aspiration: Report of a case and review of pathogenesis

    Directory of Open Access Journals (Sweden)

    Yakoushina Tatiana

    2010-01-01

    Full Text Available Pituitary carcinoma (PC is a very rare entity (0.2% of all pituitary tumors, with only about 140 cases reported in English literature. There are no reliable histological, immunohistochemical or ultrastructural features distinguishing pituitary adenoma (PA from PC. By definition, a diagnosis of PC is made after a patient with PA develops non-contiguous central nervous system (CNS or systemic metastases. To date, only three cases of PC have been reportedly diagnosed on fine needle aspiration (FNA. Two of the reported cases were diagnosed on FNA of the cervical lymph nodes and one on FNA of the vertebral bone lesion. Herein, we present a case of PC, diagnosed on FNA of the liver lesion. In this case, we describe cytologic features of PC and compare them to histologic features of the tumor in the pituitary. Clinical behavior of tumor, pathogenesis of metastasis and immunochemical and prognostic markers will also be described.

  8. Hypercalcemic crisis due to a mediastinal parathyroid cyst diagnosed by ultrasound-guided fine needle aspiration

    Institute of Scientific and Technical Information of China (English)

    ZHU Yan; MENG Yun-xiao; LI Nai-shi; LU Lin; CHEN Shi; XING Xiao-ping; MENG Xun-wu; GUAN Heng; TAN Li; LU Ke

    2010-01-01

    @@ Hypercalcemic crisis, generally accepted as serum calcium concentration greater than 3.5 mmol/L,constitues a life-threatening endocrinologic emergency,and is most frequently caused by either primary hyperparathyroidism (PHPT) or malignant diseases.Parathyroid cysts are uncommon lesions, most of that are located in the low part of the neck. By routine neck ultrasound scan investigation in a large series of 6621 patients, only 5 parathyroid cysts were detected, yielding a prevalence of 0.075% in setting of unselected patients.The parathyroid cysts in the mediastinum are much less frequently encountered, with only 106 cases reported in English literature.2,3 Moreover, less than half of these cases presented as functional with elevated serum calcium and parathyroid hormone, and only 10 cases were associated with hypercalcemic crisis.3 Herein, we present a rare case of mediastinal parathyroid cyst associated with recurrent hypercalcemic crisis, which diagnosed by ultrasound-guided fine needle aspiration (FNA).

  9. Fine-needle aspiration cytology of granular cell tumor: A report of two cases

    Directory of Open Access Journals (Sweden)

    Pampa Ch. Toi

    2013-01-01

    Full Text Available Granular cell tumors (GCTs are uncommon soft tissue tumors, which are difficult to diagnose merely on clinical examination. Being an effective first-line investigation, the fine-needle aspiration cytology (FNAC plays a significant role in its pre-operative recognition. However, as the tumor is likely to mimic certain other lesions, a cytopathologist needs to be aware of its characteristic cytomorphology. We report two cases of GCT who presented with subcutaneous swellings in the left lower back and the right-sided anterior abdominal wall for 6 and 2 months, respectively. Both the patients had a clinical diagnosis of lipoma/neurofibroma. FNAC was done in both. In the first case a cytodiagnosis of xanthogranuloma was suggested and GCT in the second. Subsequent histologic examination of both showed features of GCT. FNAC would aid in presumptive diagnosis of GCT.

  10. Fine-needle aspiration cytology of granular cell tumor: A report of two cases.

    Science.gov (United States)

    Toi, Pampa Ch; Siddaraju, Neelaiah; Basu, Debdatta

    2013-07-01

    Granular cell tumors (GCTs) are uncommon soft tissue tumors, which are difficult to diagnose merely on clinical examination. Being an effective first-line investigation, the fine-needle aspiration cytology (FNAC) plays a significant role in its pre-operative recognition. However, as the tumor is likely to mimic certain other lesions, a cytopathologist needs to be aware of its characteristic cytomorphology. We report two cases of GCT who presented with subcutaneous swellings in the left lower back and the right-sided anterior abdominal wall for 6 and 2 months, respectively. Both the patients had a clinical diagnosis of lipoma/neurofibroma. FNAC was done in both. In the first case a cytodiagnosis of xanthogranuloma was suggested and GCT in the second. Subsequent histologic examination of both showed features of GCT. FNAC would aid in presumptive diagnosis of GCT.

  11. Fine Needle Aspiration Diagnosis of Isolated Pancreatic Tuberculosis: A Case Report and Review of Literature

    Directory of Open Access Journals (Sweden)

    D'Cruz S

    2003-07-01

    Full Text Available CONTEXT: Tuberculosis is a common disease in the developing world and its incidence is slowly increasing in developed countries where a resurgence has been seen subsequent to the AIDS epidemic. Tuberculosis, in its extrapulmonary form, though emerging as a clinical problem, rarely affects the pancreas. The pancreas is biologically protected from being infected by Mycobacterium tuberculosis. Pancreatic tuberculosis presents with a wide spectrum of symptoms such as abdominal pain, constitutional symptoms, obstructive jaundice, iron deficiency anemia, pancreatic abscess, massive gastro-intestinal bleeding, acute/chronic pancreatitis, secondary diabetes, splenic vein thrombosis and a pancreatic mass mimicking malignancy. It should be suspected clinically in patients having a pancreatic mass, particularly if the patient is young, not jaundiced, coming from an area of high tuberculosis endemicity and having a normal endoscopic retrograde cholangio-pancreatography. Its indolent course and vague symptomatology along with non-specific laboratory and radiological findings call for greater vigilance. CASE REPORT: We report a case of pancreatic tuberculosis which presented with pancreatic pain. Imaging techniques revealed a mass located in the head of the pancreatic gland. Fine needle aspiration cytology revealed caseating granulomas. The diagnosis of pancreatic tuberculosis was made and the patient was put on anti-tubercular therapy. Five months later, a repeat CT scan of the abdomen revealed resolution of the pancreatic lesion. CONCLUSION: The diagnosis of pancreatic tuberculosis is usually not suspected prior to laparotomy. Most patients have been diagnosed at laparotomy, thus fine needle aspiration cytology/biopsy is useful in obviating the need for major surgery with its accompanying morbidity. Exploratory laparotomy may be required in technically difficult cases due to risk of injury to the vessels in the vicinity of the mass.

  12. A cost evaluation methodology for surgical technologies.

    Science.gov (United States)

    Ismail, Imad; Wolff, Sandrine; Gronfier, Agnes; Mutter, Didier; Swanström, Lee L; Swantröm, Lee L

    2015-08-01

    To create and validate a micro-costing methodology that surgeons and hospital administrators can use to evaluate the cost of implementing innovative surgical technologies. Our analysis is broken down into several elements of fixed and variable costs which are used to effectively and easily calculate the cost of surgical operations. As an example of application, we use data from 86 robot assisted gastric bypass operations made in our hospital. To validate our methodology, we discuss the cost reporting approaches used in 16 surgical publications with respect to 7 predefined criteria. Four formulas are created which allow users to import data from their health system or particular situation and derive the total cost. We have established that the robotic surgical system represents 97.53 % of our operating room's medical device costs which amounts to $4320.11. With a mean surgery time of 303 min, personnel cost per operation amounts to $1244.73, whereas reusable instruments and disposable costs are, respectively, $1539.69 and $3629.55 per case. The literature survey demonstrates that the cost of surgery is rarely reported or emphasized, and authors who do cover this concept do so with variable methodologies which make their findings difficult to interpret. Using a micro-costing methodology, it is possible to identify the cost of any new surgical procedure/technology using formulas that can be adapted to a variety of operations and healthcare systems. We hope that this paper will provide guidance for decision makers and a means for surgeons to harmonise cost reporting in the literature.

  13. Effectiveness of cricoid pressure in preventing gastric aspiration during rapid sequence intubation in the emergency department: study protocol for a randomised controlled trial

    Directory of Open Access Journals (Sweden)

    Trethewy Christopher E

    2012-02-01

    Full Text Available Abstract Background Cricoid pressure is considered to be the gold standard means of preventing aspiration of gastric content during Rapid Sequence Intubation (RSI. Its effectiveness has only been demonstrated in cadaveric studies and case reports. No randomised controlled trials comparing the incidence of gastric aspiration following emergent RSI, with or without cricoid pressure, have been performed. If improperly applied, cricoid pressure increases risk to the patient. The clinical significance of aspiration in the emergency department is unknown. This randomised controlled trial aims to; 1. Compare the application of the 'ideal" amount of force (30 - 40 newtons to standard, unmeasured cricoid pressure and 2. Determine the incidence of clinically defined aspiration syndromes following RSI using a fibrinogen degradation assay previously described. Methods/design 212 patients requiring emergency intubation will be randomly allocated to either control (unmeasured cricoid pressure or intervention groups (30 - 40 newtons cricoid pressure. The primary outcome is the rate of aspiration of gastric contents (determined by pepsin detection in the oropharyngeal/tracheal aspirates or treatment for aspiration pneumonitis up to 28 days post-intubation. Secondary outcomes are; correlation between aspiration and lowest pre-intubation Glasgow Coma Score, the relationship between detection of pepsin in trachea and development of aspiration syndromes, complications associated with intubation and grade of the view on direct largyngoscopy. Discussion The benefits and risks of cricoid pressure application will be scrutinised by comparison of the incidence of aspiration and difficult or failed intubations in each group. The role of cricoid pressure in RSI in the emergency department and the use of a pepsin detection as a predictor of clinical aspiration will be evaluated. Trial registration Australian New Zealand Clinical Trials Registry (ANZCTR: ACTRN12611000587909

  14. Surgical Treatment of Atrial Fibrillation: A Review

    Directory of Open Access Journals (Sweden)

    Nadine Hiari

    2011-01-01

    Full Text Available Atrial fibrillation is the most commonly sustained arrhythmia in man. While it affects millions of patients worldwide, its incidence will markedly increase with an aging population. Primary goals of AF therapy are to (1 reduce embolic complications, particularly stroke, (2 alleviate symptoms, and (3 prevent long-term heart remodelling. These have been proven to be a challenge as there are major limitations in our knowledge of the pathological and electrophysiological mechanisms underlying AF. Although advances continue to be made in the medical management of this condition, pharmacotherapy is often unsuccessful. Because of the high recurrence rate of AF despite antiarrhythmic drug therapy for maintenance of sinus rhythm and the adverse effects of these drugs, there has been growing interest in nonpharmacological strategies. Surgery for treatment of AF has been around for some time. The Cox-Maze procedure is the gold standard for the surgical treatment of atrial fibrillation and has more than 90% success in eliminating atrial fibrillation. Although the cut and sew maze is very effective, it has been superseded by newer operations that rely on alternate energy sources to create lines of conduction block. In addition, the evolution of improved ablation technology and instrumentation has facilitated the development of minimally invasive approaches. In this paper, the rationale for surgical ablation for atrial fibrillation and the different surgical techniques that were developed will be explored. In addition, it will detail the new approaches to surgical ablation of atrial fibrillation that employ alternate energy sources.

  15. Abortion - surgical

    Science.gov (United States)

    Suction curettage; Surgical abortion; Elective abortion - surgical; Therapeutic abortion - surgical ... Surgical abortion involves dilating the opening to the uterus (cervix) and placing a small suction tube into the uterus. ...

  16. Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration of Undiagnosed Chest Tumors

    DEFF Research Database (Denmark)

    Eckardt, Jens; Olsen, Karen E; Licht, Peter B

    2010-01-01

    BACKGROUND: A number of patients with radiologically suspicious chest tumors remain undiagnosed despite bronchoscopy or CT-guided fine-needle aspiration (CT-FNA). Such patients are often referred for mediastinoscopy, which is an invasive surgical procedure that poses a small but significant risk...

  17. The Application of a Multiphase Triangulation Approach to Mixed Methods: The Research of an Aspiring School Principal Development Program

    Science.gov (United States)

    Youngs, Howard; Piggot-Irvine, Eileen

    2012-01-01

    Mixed methods research has emerged as a credible alternative to unitary research approaches. The authors show how a combination of a triangulation convergence model with a triangulation multilevel model was used to research an aspiring school principal development pilot program. The multilevel model is used to show the national and regional levels…

  18. Creating Sustainable Relationships Using the Strengths, Opportunities, Aspirations and Results Framework, Trust, and Environmentalism: A Research-Based Case Study

    Science.gov (United States)

    Sprangel, Joseph; Stavros, Jacqueline; Cole, Matthew

    2011-01-01

    New forms of organization development are moving from a classical diagnostic perspective to a dialogic perspective. This move includes a focus on exploring positive states of organizing, shared aspirations, and the design of preferred futures as key outcomes of a strategic change process. Training and development that applies the elements of the…

  19. The Application of a Multiphase Triangulation Approach to Mixed Methods: The Research of an Aspiring School Principal Development Program

    Science.gov (United States)

    Youngs, Howard; Piggot-Irvine, Eileen

    2012-01-01

    Mixed methods research has emerged as a credible alternative to unitary research approaches. The authors show how a combination of a triangulation convergence model with a triangulation multilevel model was used to research an aspiring school principal development pilot program. The multilevel model is used to show the national and regional levels…

  20. Fine needle aspiration cytology of chondroblastoma: A report of two cases with brief review of pitfalls

    Directory of Open Access Journals (Sweden)

    Amita Krishnappa

    2016-01-01

    Full Text Available Chondroblastoma is a rare, giant cell-rich, benign neoplasm of bone. Since the past few decades fine needle aspiration cytology (FNAC has gained momentum in preoperative diagnosis of bone lesions. At cytology, other giant cell-rich tumors and tumorlike lesions such as aneurysmal bone cyst (ABC, giant cell tumor, and chondromyxoid fibroma fall under the differential diagnosis of chondroblastoma. Due to the difference in the treatment protocol and prognosis, preoperative diagnosis is mandatory. We describe the cytomorphology in two cases of chondroblastoma diagnosed at FNAC and confirmed by histopathology. At cytology, the presence of giant cells, chondroid matrix, mononuclear cells with nuclear indentation, and grooving along with glassy, vacuolated cytoplasm are characteristic of chondroblastoma. In addition to this, the presence of chicken wire calcification is a useful clue to the accurate diagnosis of chondroblastoma at FNAC.

  1. Fine needle aspiration cytology of chondroblastoma: A report of two cases with brief review of pitfalls.

    Science.gov (United States)

    Krishnappa, Amita; Shobha, S N; Shankar, S Vijay; Aradhya, Sushma

    2016-01-01

    Chondroblastoma is a rare, giant cell-rich, benign neoplasm of bone. Since the past few decades fine needle aspiration cytology (FNAC) has gained momentum in preoperative diagnosis of bone lesions. At cytology, other giant cell-rich tumors and tumorlike lesions such as aneurysmal bone cyst (ABC), giant cell tumor, and chondromyxoid fibroma fall under the differential diagnosis of chondroblastoma. Due to the difference in the treatment protocol and prognosis, preoperative diagnosis is mandatory. We describe the cytomorphology in two cases of chondroblastoma diagnosed at FNAC and confirmed by histopathology. At cytology, the presence of giant cells, chondroid matrix, mononuclear cells with nuclear indentation, and grooving along with glassy, vacuolated cytoplasm are characteristic of chondroblastoma. In addition to this, the presence of chicken wire calcification is a useful clue to the accurate diagnosis of chondroblastoma at FNAC.

  2. Chest CT findings in patients with dysphagia and aspiration: a systematic review.

    Science.gov (United States)

    Scheeren, Betina; Gomes, Erissandra; Alves, Giordano; Marchiori, Edson; Hochhegger, Bruno

    2017-07-31

    The objective of this systematic review was to characterize chest CT findings in patients with dysphagia and pulmonary aspiration, identifying the characteristics and the methods used. The studies were selected from among those indexed in the Brazilian Virtual Library of Health, LILACS, Indice Bibliográfico Español de Ciencias de la Salud, Medline, Cochrane Library, SciELO, and PubMed databases. The search was carried out between June and July of 2016. Five articles were included and reviewed, all of them carried out in the last five years, published in English, and coming from different countries. The sample size in the selected studies ranged from 43 to 56 patients, with a predominance of adult and elderly subjects. The tomographic findings in patients with dysphagia-related aspiration were varied, including bronchiectasis, bronchial wall thickening, pulmonary nodules, consolidations, pleural effusion, ground-glass attenuation, atelectasis, septal thickening, fibrosis, and air trapping. Evidence suggests that chest CT findings in patients with aspiration are diverse. In this review, it was not possible to establish a consensus that could characterize a pattern of pulmonary aspiration in patients with dysphagia, further studies of the topic being needed. RESUMO O objetivo deste estudo foi realizar uma revisão sistemática dos achados de TC de tórax que caracterizem aspiração pulmonar em pacientes com disfagia, identificando as características e os métodos utilizados. Para a seleção dos estudos, foram utilizadas as bases de dados da Biblioteca Virtual em Saúde, LILACS, Indice Bibliográfico Español de Ciencias de la Salud, Medline, Biblioteca Cochrane, SciELO e PubMed. A busca foi realizada no período entre junho e julho de 2016. Foram incluídos e revisados cinco artigos, todos realizados nos últimos cinco anos, publicados em língua inglesa e oriundos de diferentes países. O tamanho da amostra nos estudos selecionados variou de 43 a 56 pacientes

  3. Non-surgical treatment of esophageal achalasia

    Institute of Scientific and Technical Information of China (English)

    Vito Annese; Gabrio Bassotti

    2006-01-01

    Esophageal achalasia is an infrequent motility disorder characterized by a progressive stasis and dilation of the oesophagus; with subsequent risk of aspiration,weight loss, and malnutrition. Although the treatment of achalasia has been traditionally based on a surgical approach, especially with the introduction of laparoscopic techniques, there is still some space for a medical approach. The present article reviews the non-surgical therapeutic options for achalasia.

  4. Surfactant dysfunction in lung contusion with and without superimposed gastric aspiration in a rat model.

    Science.gov (United States)

    Raghavendran, Krishnan; Davidson, Bruce A; Knight, Paul R; Wang, Zhengdong; Helinski, Jadwiga; Chess, Patricia R; Notter, Robert H

    2008-11-01

    This study investigates surfactant dysfunction in rats with lung contusion (LC) induced by blunt chest trauma. Rats at 24 h postcontusion had a decreased percent content of large surfactant aggregates in cell-free bronchoalveolar lavage (BAL) and altered large-aggregate composition with decreased phosphatidylcholine (PC), increased lyso-PC, and increased protein compared with uninjured controls. The surface activity of large aggregates on a pulsating bubble surfactometer was also severely impaired at 24 h postcontusion. Decreases in large surfactant aggregate content and surface activity were improved, but still apparent, at 48 and 72 h postcontusion compared with uninjured control rats and returned to normal by 96 h postcontusion. The functional importance of surfactant abnormalities in LC injury was documented in pilot studies showing that exogenous surfactant replacement at 24 h postcontusion improved inflation/deflation lung volumes. Additional experiments investigated a clinically relevant combination of LC plus gastric aspiration (combined acid and small gastric food particles) and found reductions in large surfactant aggregates in BAL similar to those for LC. However, rats given LC + combined acid and small gastric food particles versus LC had more severe surfactant dysfunction based on decreases in surface activity and alterations in large aggregate composition. Combined data for all animal groups had strong statistical correlations between surfactant dysfunction (increased minimum surface tension, decreased large aggregates in BAL, decreased aggregate PC, and increased aggregate lyso-PC) and the severity of inflammatory lung injury (increased total protein, albumin, protein/phospholipid ratio, neutrophils, and erythrocytes in BAL plus increased whole lung myeloperoxidase activity). These results show that surfactant dysfunction is important in the pathophysiology of LC with or without concurrent gastric aspiration and provides a rationale for surfactant

  5. Sensory cutaneous nerve fine-needle aspiration in Hansen′s disease: A retrospective analysis of our experience

    Directory of Open Access Journals (Sweden)

    Dev Prasoon

    2015-01-01

    Conclusion: Sensory cutaneous nerve fine-needle aspiration (FNA is a feasible, viable, effective, and safe procedure. It adds to diagnostic FNA yield in patients with concomitant skin involvement and offers a way to evaluate patients with only nerve involvement. Calculation of morphological index allows prognostication and may have a role in assessing response to therapy and/or relapse.

  6. Aspergillus thyroiditis: first antemortem case diagnosed by fine-needle aspiration culture in a pediatric stem cell transplant patient.

    Science.gov (United States)

    Badawy, S M; Becktell, K D; Muller, W J; Schneiderman, J

    2015-12-01

    Aspergillus thyroiditis (AT) has historically been considered a postmortem diagnosis in immunocompromised patients; most have disseminated disease. This report summarizes the clinical challenge of diagnosing AT. It also highlights the value of the early use of thyroid fine-needle aspiration culture and the need for a high index of suspicion to reach the final diagnosis before disease dissemination.

  7. Pilot Testing of a Parent-Directed Intervention (Project ASPIRE) for Underserved Children Who Are Deaf or Hard of Hearing

    Science.gov (United States)

    Sacks, Chana; Shay, Sophie; Repplinger, Lyra; Leffel, Kristin R.; Sapolich, Shannon G.; Suskind, Elizabeth; Tannenbaum, Sally; Suskind, Dana

    2014-01-01

    This pilot study explored the potential for Project ASPIRE to effect behavior change in a sample of 11 parents of children with hearing loss who were from typically underserved populations, such as families from backgrounds of low socioeconomic status or families who speak English as a second language. The study consisted of one education session,…

  8. Surgical resection of a giant cardiac fibroma.

    Science.gov (United States)

    Stamp, Nikki L; Larbalestier, Robert I

    2016-05-01

    A 42-year-old woman presented to a regional hospital emergency room with palpitations and was found to be in ventricular tachycardia. Chest radiography demonstrated a massively enlarged cardiac silhouette. Echocardiography and cardiac magnetic resonance imaging demonstrated a mass within the left ventricular free wall, consistent with a cardiac fibroma. The patient proceeded to have surgical resection of the mass. Left ventricular function was preserved postoperatively.

  9. Nasal packing aspiration in a patient with Alzheimer’s disease: a rare complication

    Directory of Open Access Journals (Sweden)

    Papadakis I

    2012-07-01

    Full Text Available Eleftherios Koudounarakis, Nikolaos Chatzakis, Ioannis Papadakis, Irene Panagiotaki, George VelegrakisDepartment of Otorhinolaryngology, University Hospital of Heraklion, Crete, GreeceAbstract: Nasal bleeding is a frequent problem for patients receiving anticoagulant agents. Most cases are successfully managed with anterior or posterior nasal packing. However, the complications of nasal packing should be always considered. We report the case of a 78-year-old man with Alzheimer’s disease who was treated for anterior epistaxis with anterior nasal packing using three pieces of antibiotic-soaked gauze. Two days later, the patient was admitted to the emergency department in respiratory distress. A chest x-ray demonstrated atelectasis of the right lung. During an examination of the nasal cavities, the nasal packing was removed, and one of the gauze pieces was missing. The patient underwent rigid bronchoscopy, and the missing gauze was found to be obstructing the right main bronchus. The patient’s respiratory function improved considerably after removal of the foreign body. It is assumed that gauze packs should be used with caution in patients with an impaired level of consciousness and neurodegenerative diseases.Keywords: epistaxis, nasal packing, aspiration, Alzheimer’s disease, cough reflex

  10. The Difference between Ideal and Actual Fasting Duration in the Treatment of Patients with Aspiration Pneumonia: A Nationwide Survey of Clinicians in Japan.

    Science.gov (United States)

    Kenzaka, Tsuneaki; Kosami, Koki; Matsuoka, Yasufumi; Noda, Ayako; Kumabe, Ayako

    2016-11-01

    In Japan, aspiration pneumonia is common among the elderly and patients are often treated by temporary discontinuation of meals. However, there are few published studies on the fasting duration for aspiration pneumonia treatment. Therefore, we conducted the present study to assess the opinions of clinicians regarding the fasting duration for the treatment of patients with aspiration pneumonia and the actual medical practice with regard to oral ingestion in hospitalized patients with aspiration pneumonia. We targeted hospitals with internal medicine and respiratory medicine departments across Japan. A questionnaire regarding the fasting duration for aspiration pneumonia treatment and oral ingestion in hospitalized patients with aspiration pneumonia was mailed to physicians treating patients with pneumonia at 2,490 hospitals. We received appropriate responses from 350 facilities (response rate, 14.1%). Most clinicians (78.3%) responded that it best to keep the fasting duration for treatment as short as possible and considered that fasting is absolutely unnecessary. Regarding oral ingestion in hospitalized patients, more than 25% of clinicians restricted oral intake for a certain number of days. The majority of these clinicians (53.3%) preferred prolonged fasting for 3 to 7 days. Although most physicians preferred the fasting duration to be as short as possible, there was a difference between the ideal and actual scenarios in reintroducing oral intake early in patients with aspiration pneumonia. Improving physicians' knowledge and experience will bridge the gap between the ideal situation and what currently occurs. Further studies should investigate the acceptable fasting duration for the treatment of aspiration pneumonia.

  11. Surgical care in the Solomon Islands: a road map for universal surgical care delivery.

    Science.gov (United States)

    Natuzzi, Eileen S; Kushner, Adam; Jagilly, Rooney; Pickacha, Douglas; Agiomea, Kaeni; Hou, Levi; Houasia, Patrick; Hendricks, Phillip L; Ba'erodo, Dudley

    2011-06-01

    Access to surgical care and emergency obstetrical care is limited in low-income countries. The Solomon Islands is one of the poorest countries in the Pacific region. Access to surgical care in Solomon Islands is limited and severely affected by a country made up of islands. Surgical care is centralized to the National Referral Hospital (NRH) on Guadalcanal, leaving a void of care in the provinces where more than 80% of the people live. To assess the ability to provide surgical care to the people living on outer islands in the Solomon Islands, the provincial hospitals were evaluated using the World Health Organization's Global Initiative for Emergency and Essential Surgical Care Needs Assessment Tool questionnaire. Data on infrastructure, workforce, and equipment available for treating surgical disease was collected at each provincial hospital visited. Surgical services are centralized to the NRH on Guadalcanal in Solomon Islands. Two provincial hospitals provide surgical care when a surgeon is available. Six of the hospitals evaluated provide only very basic surgical procedures. Infrastructure problems exist at every hospital including lack of running water, electricity, adequate diagnostic equipment, and surgical supplies. The number of surgeons and obstetricians employed by the Ministry of Health is currently inadequate for delivering care at the outer island hospitals. Shortages in the surgical workforce can be resolved in Solomon Islands with focused training of new graduates. Training surgeons locally, in the Pacific region, can minimize the "brain drain." Redistribution of surgeons and obstetricians to the provincial hospitals can be accomplished by creating supportive connections between these hospitals, the NRH, and international medical institutions.

  12. The diagnosis and management of synovial cysts: Efficacy of surgery versus cyst aspiration.

    Science.gov (United States)

    Epstein, Nancy E; Baisden, Jamie

    2012-01-01

    The surgical management of lumbar synovial cysts that have extruded into the spinal canal remains controversial (e.g. decompression with/without fusion). The neurological presentation, anatomy, pathophysiology, and surgical challenges posed by synovial cysts in the lumbar spine are well known. Neurological complaints typically include unilateral or, more rarely, bilateral radicular complaints, and/or cauda equina syndromes. Anatomically, synovial cysts constitute cystic dilatations of synovial sheaths that directly extrude from facet joints into the spinal canal. Pathophysiologically, these cysts reflect disruption of the facet joints often with accompanying instability, and potentially compromise both the cephalad and caudad nerve roots. Aspiration of lumbar synovial cysts, which are typically gelatinous and non-aspirable, and typically performed by "pain specialists" (e.g. pain management, rehabilitation, radiologists, others) utilizing fluoroscopy or CT-guided aspiration, is associated with 50-100% failure rates. Surgical decompression with/without fusion (as the issue regarding fusion remains unsettled) results in the resolution of back and radicular pain in 91.6-92.5% and 91.1-91.9% of cases, respectively. After a thorough review of the literature, it appears that the treatment with the best outcome for patients with synovial cysts is cyst removal utilizing surgical decompression; the need for attendant fusion remains unsettled. The use of an alternative treatment, percutaneous aspiration of cysts, appears to have a much higher recurrence and failure rate, but may be followed by surgery if warranted.

  13. A Cross-Sectional Study of Career Aspirations in Thai Children in an International School in Bangkok

    Science.gov (United States)

    McDevitt, Teresa M.; Hess, Chelsie A.; Leesatayakun, Mantmart; Sheehan, Eugene P.; Kaufeld, Kimberly A.

    2013-01-01

    This investigation employed exploratory methods to examine career aspirations in 141 students in Grades 4, 6, 8, 10, and 12 from an international school in Bangkok. Students specified the jobs that they were most likely to pursue as adults, rated the importance of potential influences in making career decisions, and drew a picture of themselves in…

  14. Duodenal Aspirates for Small Intestine Bacterial Overgrowth: Yield, PPIs, and Outcomes after Treatment at a Tertiary Academic Medical Center

    Directory of Open Access Journals (Sweden)

    Diana L. Franco

    2015-01-01

    Full Text Available Duodenal aspirates are not commonly collected, but they can be easily used in detection of small intestinal bacterial overgrowth (SIBO. Proton pump inhibitor (PPI use has been proposed to contribute to the development of SIBO. We aimed to determine the yield of SIBO-positive cultures detected in duodenal aspirates, the relationship between SIBO and PPI use, and the clinical outcomes of patients identified by this method. In a retrospective study, we analyzed electronic medical records from 1263 consecutive patients undergoing upper endoscopy at a tertiary medical center. Aspirates were collected thought out the third and fourth portions of the duodenum, and cultures were considered to be positive for SIBO if they produced more than 100,000 cfu/mL. Culture analysis of duodenal aspirates identified SIBO in one-third of patients. A significantly higher percentage of patients with SIBO use PPIs than patients without SIBO, indicating a possible association. Similar proportions of patients with SIBO improved whether or not they received antibiotic treatment, calling into question the use of this expensive therapy for this disorder.

  15. A Novel Design of Needle Aspiration Biopsy Monitoring Instrument (NAOMI Tested on a Low Cost Chest Phantom

    Directory of Open Access Journals (Sweden)

    Surakusumah Rino Ferdian

    2016-01-01

    Full Text Available Needle biopsy is a medical intervention method for taking a lung tissue sample that suspected as a cancer. The disadvantage is the physicians directly visualize the anatomical structures in an open surgery for lung cancer biopsy procedure. There is a need to develop an instrument that may help the physician to guarantee the accuracy and efficiency while performing needle aspiration biopsy. Therefore, a needle aspiration biopsy monitoring instrument or named as NAOMI is proposed. It consists of a microcontroller system, an IMU sensor, an ultrasonic ranging module, a bluetooth module, and a 9V lithium battery. The experimental testing consist of performance testing, functional testing using chest phantom, and user acceptances. The results showed that the NAOMI improve the accuracy and efficiency while performing the needle biopsy operation.

  16. Language and Aspiration of the Students on Global Outlook: a Review Based on Malaysia Education Development Plan (2013- 2025

    Directory of Open Access Journals (Sweden)

    Sharipah Nur Mursalina Syed Azmy

    2016-11-01

    Full Text Available The Malaysia Education Development Plan (2013 – 2025 (pre-school to post-secondary education was launched by the Ministry of Education on October 2011. This plan aimed at transforming the national education system holistically and was based upon the international standard to instil the national aspiration and to prepare the students with sufficient competitive edge when upon completion of their study. This paper reviewed the six aspirations outlined in the Malaysia Education Development Plan which encompassed knowledge, thinking skills, leadership skills, bilingual skills, ethics and spirituality, and national identity. Each of these elements provide a holistic approach in ensuring the students are well equipped not only with knowledge and soft skills, but most instrumentally they are able to engulf the spirit of national identity. This is highly important in today’s world as without it, the country would not be able to move forward with its Vision 2020 when the people are not united and prepared to strive for excellence. This paper discovered that the six aspirations listed in the Malaysia Education Development Plan are embedded strategically in each of the thrust in developing the new generation of students. Keywords: Malaysia Education Development Plan, knowledge, development, national identity, students, aspirations.

  17. Aspiration Thrombectomy Using a Guiding Catheter in Acute Lower Extremity Deep Vein Thrombosis: Usefulness of the Calf-Squeeze Technique

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Jae A; Kwak, Hyo Sung; Han, Young Min; Yu, Hee Chul [Chonbuk National University Medical School, Jeonju (Korea, Republic of)

    2011-05-15

    The effectiveness of the calf-squeeze technique during aspiration thrombectomy using guiding catheter in the treatment of an acute lower extremity deep vein thrombosis (DVT) was evaluated by the use of imaging and the clinical follow-up of patients. A prospective analysis of ten patients (seven women, three men; median age, 56.9 years) with common iliac vein (CIV) obstruction and ipsilateral DVT was performed for this study. All patients presented with leg edema or pain and were treated with catheter-directed thrombolysis via an ipsilateral popliteal vein approach after insertion of a temporary inferior vena cava (IVC) filter. Subsequently, the patients were treated with by aspiration thrombectomy using a guiding catheter to remove the residual thrombus. The calf-squeeze technique during aspiration thrombectomy can be used to induce the proximal migration of thrombi in the popliteal, tibial, and muscular veins were used to increase venous flow. The calf-squeeze technique was employed at mean of 1.3 times (range, 1-3 times). All patients showed proximal migration of a popliteal and muscular vein thrombus during the execution of the calf-squeeze technique. Successful recanalization was achieved in all patients (100%) without any complications. On duplex ultrasonography, which was performed immediately after the aspiration thrombectomy, four patients had a residual thrombus in the soleal muscular veins. However, none of the patients had a thrombus in the popliteal and tibial veins; and, during follow-up, no DVT recurred in any patient. The use of the calf-squeeze technique during aspiration thrombectomy after catheter-directed thrombolysis can induce the proximal migration of thrombi in the popliotibial and muscular veins and is an effective method that can remove a thrombus in calf veins.

  18. Smoking and Bone Healing - A Risky Surgical Combination

    Science.gov (United States)

    ... Risky Surgical Combination A A A | Print | Share Smoking and Bone Healing – A Risky Surgical Combination Imagine ... saying that they'd prefer patients to quit smoking. There hasn't been a great deal of ...

  19. Surgical Treatment of Paraesophageal Hernias: A Review.

    Science.gov (United States)

    Andolfi, Ciro; Jalilvand, Anahita; Plana, Alejandro; Fisichella, P Marco

    2016-10-01

    The management of paraesophageal hernia (PEH) can be challenging due to the lack of consensus regarding indications and principles of operative treatment. In addition, data about the pathophysiology of the hernias are scant. Therefore, the goal of this review is to shed light and describe the classification, pathophysiology, clinical presentation, and indications for treatment of PEHs, and provide an overview of the surgical management and a description of the technical principles of the repair.

  20. Brown recluse spider bites. A comparison of early surgical excision versus dapsone and delayed surgical excision.

    Science.gov (United States)

    Rees, R S; Altenbern, D P; Lynch, J B; King, L E

    1985-01-01

    In a prospective study, 31 patients with brown recluse spider bites were treated by either immediate surgical excision or with the leukocyte inhibitor, dapsone, followed by delayed surgical excision. Patients were matched for age, gender, and lesion size and were excluded if the typical history and physical findings were not present. In patients treated with immediate surgical excision (N = 14), delayed wound healing (N = 5) and objectional scarring (N = 7) were common complications. However, pretreatment treatment with dapsone reduced the incidence of wound complications (N = 1) and objectional scarring (N = 1) (p less than 0.05), while reducing the need for surgical excision (N = 1). There were no severe drug reactions due to dapsone, although one patient had persistent G.I. upset. Pretreatment with dapsone not only reduced surgical complications but also improved the outcome of patients bitten by the brown recluse spider. PMID:4051613

  1. Effectiveness of a 1-day aspiration plus Gamma Knife surgery procedure for metastatic brain tumor with a cystic component.

    Science.gov (United States)

    Higuchi, Fumi; Kawamoto, Shunsuke; Abe, Yoshihiro; Kim, Phyo; Ueki, Keisuke

    2012-12-01

    Gamma Knife surgery (GKS) has gained increasing relevance in the treatment of metastatic brain tumors, but many metastatic tumors contain a large cystic component and often exceed the size limit for GKS. For such lesions, the authors adopted a procedure in which stereotactic aspiration is first performed and followed immediately by GKS on the same day. In this paper, the authors describe this 1-day combined procedure and evaluate its efficacy. Between 2005 and 2010, 25 cystic metastases in 25 patients were treated at Dokkyo Medical University. The patients first underwent MRI and stereotactic aspiration of the cyst while stationary in a Leksell stereotactic frame; immediately afterward, the patients underwent a second MR imaging session and Gamma Knife treatment. Tumor volume reduction, tumor control rate, and overall survival were examined. Tumor volume, including the cystic component, decreased from 8.0-64.2 cm(3) (mean 20.3 cm(3)) to 3.0-36.2 cm(3) (mean 10.3 cm(3)) following aspiration, and the volume of 24 of 25 lesions decreased to less than 16.6 cm(3), which is equivalent to the volume of a 3.16-cm sphere. At least 20 Gy was delivered to the entire lesion in 24 of 25 cases. Good tumor control was obtained in 16 of 21 cases that could be evaluated during a median follow-up period of 11 months (range 1-27 months); however, reaccumulation of cyst contents was observed in 2 patients who required Ommaya reservoir placement. The 1-day aspiration plus GKS procedure is an effective and time-efficient treatment for large cystic brain metastases.

  2. Intraoperative monitoring technician: a new member of the surgical team.

    Science.gov (United States)

    Brown, Molly S; Brown, Debra S

    2011-02-01

    As surgery needs have increased, the traditional surgical team has expanded to include personnel from radiology and perfusion services. A new surgical team member, the intraoperative monitoring technician, is needed to perform intraoperative monitoring during procedures that carry a higher risk of central and peripheral nerve injury. Including the intraoperative monitoring technician on the surgical team can create challenges, including surgical delays and anesthesia care considerations. When the surgical team members, including the surgeon, anesthesia care provider, and circulating nurse, understand and facilitate this new staff member's responsibilities, the technician is able to perform monitoring functions that promote the smooth flow of the surgical procedure and positive patient outcomes.

  3. Diagnostic investigation of parotid neoplasms: a 16-year experience of freehand fine needle aspiration cytology and ultrasound-guided core needle biopsy.

    Science.gov (United States)

    Haldar, S; Mandalia, U; Skelton, E; Chow, V; Turner, S S; Ramesar, K; Tighe, D; Williams, M; Howlett, D

    2015-02-01

    This study aimed to examine the diagnostic yield of fine needle aspiration cytology (FNAC) and ultrasound-guided core needle biopsy (USCB) in the diagnosis of parotid neoplasia. A 16-year retrospective analysis was performed of patients entered into our pathology database with a final diagnosis of parotid neoplasia. FNAC and USCB data were compared to surgical excision where available. One hundred and twenty FNAC, 313 USCB, and 259 surgical specimens were analyzed from 397 patients. Fifty-six percent of FNAC and 4% of USCB were non-diagnostic. One hundred and thirty-two (33%) patients had a final diagnosis made by USCB and did not undergo surgery. Surgery was performed in 257 (65%) patients, 226 (88%) of whom had a preoperative biopsy. Most lesions were benign, but there were 62 parotid and 13 haematological malignancies diagnosed; false-negative results were obtained in three FNAC and two USCB samples. The sensitivity and specificity of FNAC were 70% and 89%, respectively, and for USCB were 93% and 100%, respectively. This study represents the largest series of patients with a parotid neoplasm undergoing USCB for diagnosis. USCB is highly accurate with a low non-diagnostic rate and should be considered an integral part of parotid assessment. Copyright © 2014. Published by Elsevier Ltd.

  4. Use of EndoVac System for Aspiration of Exudates from a Large Periapical Lesion: A Case Report.

    Science.gov (United States)

    Keleş, Ali; Alçin, Hatice

    2015-10-01

    Large cyst-like periapical lesions can heal after nonsurgical root canal treatment. Decreasing the hydrostatic pressure within a periapical lesion can be achieved with the aspiration technique by using EndoVac when there is drainage of cystic fluid through the canals. Clinical examination of a 21-year-old male patient revealed a large periapical lesion extending from the distal aspect of tooth #26 and reaching the mesial surface of tooth #22. During root canal treatment of teeth #23, #24, and #26, serous exudate drained from the root canal of tooth #24. The MacroCannula component of EndoVac apical negative pressure irrigation system was used to aspirate the inflammatory fluid. The technique produces a vacuum effect in the periapical region through the root canal, which facilitates evacuation of large amounts of exudate. Two-year clinical and radiographic examinations revealed resolution of the mandibular radiolucency, and the adjacent tooth #25 retained its vitality. The healing of a large periapical lesion can be achieved by the correct diagnosis and the proper treatment approach, without the need for surgery. EndoVac negative irrigation system might be useful for intracanal aspiration of exudates. Copyright © 2015 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

  5. An Aspirational Community Theory of the Firm

    DEFF Research Database (Denmark)

    Li, Xin

    contractual labor and aspirational labor, the former being defined as services provided by a laborer in fulfillment of a contract while the latter as services provided by a laborer in pursuit of an aspiration; and argue that firms exist because while the market may be effective and efficient for allocating...... propose an aspirational community theory of the firm (ACT) as a candidate theory by conceptualizing the firm as an aspirational community, the core of which is a group of like-minded people sharing similar or same aspiration/vision. To explain the existence of the firm, we make a distinction between...... contractual labor it is less effective and efficient than the firms for allocating aspirational labor....

  6. Paul of Aegina's surgical instruments: a complete surgical instrumentarium in the seventh century AD.

    Science.gov (United States)

    Papadakis, Marios; de Bree, Eelco; Trompoukis, Constantinos; Manios, Andreas

    2015-03-02

    Although current progress in surgical instruments is oriented towards stapler devices, minimally invasive instrumentation and advanced cautery tools, it definitely seems intriguing to determine what instruments were used in antiquity and to appraise their use. Most adequate information can be retrieved from manuscripts of early medical authors, of whom Paul of Aegina (AD 625-690), also being a most important surgeon, is the most recent. The aim of this study is to present surgical instruments used in his practice. Surgical instruments mentioned in the original Greek text of his monumental work named Epitome of Medicine were sought using computer software. Further, similar research was performed on other significant manuscripts of earlier Greek medical writers to determine whether some of the instruments were exclusively mentioned by Paul of Aegina. In total, 121 different surgical instruments were identified and described in detail in the Epitome of Medicine. Thirty-three instruments (27%) were exclusively reported by Paul of Aegina. In antiquity a large number of surgical instruments were already being used. Paul of Aegina described in detail a large variety of fine, as well as a substantial number of, original surgical instruments, which he himself used in a wide spectrum of surgical operations. © 2015 Royal Australasian College of Surgeons.

  7. Tracheobronchial Foreign Body Aspiration: Dental Prosthesis

    Directory of Open Access Journals (Sweden)

    Ataman Köse

    2014-01-01

    Full Text Available It is important to extract foreign bodies for avoiding life-threatening complications. They can lead to death if they are not treated. Different signs and symptoms could occur according to the complete or partial airway obstruction. Foreign body aspiration is a rare incident in adults. The organic foreign materials such as foods are found to be aspirated more commonly and are usually settled in the right bronchial system. However, dental prosthesis and teeth aspirations are rare in literature. In our study, a 52-year-old male patient who had aspirated the front part of his lower dental prosthesis accidentally is presented and the foreign body is extracted by using rigid bronchoscopy. There are many causes of aspiration but dental prosthetic aspirations should be kept in mind during sleep. For this reason, dental apparatus must be taken out while asleep.

  8. Cutaneous Sinus Formation Is a Rare Complication of Thyroid Fine Needle Aspiration Biopsy

    Directory of Open Access Journals (Sweden)

    Gülhan Akbaba

    2014-01-01

    Full Text Available Fine needle aspiration biopsy (FNAB is essential in the diagnosis and management of thyroid nodules. In this paper, we report a rare complication, cutaneous sinus formation, after diagnostic FNAB guided by palpation. Sixty-three-year-old female patient was admitted with the complaints of hoarseness and discharge from the anterior neck wall which were present for the last 6 months. The patient underwent a near total thyroidectomy 17 years ago. Recurrent nodular goiter was detected six months before and a diagnostic FNAB guided by palpation was performed. Two weeks later the patient had wound discharge and hoarseness. Physical examination of the patient revealed a sinus, which was located superior to the thyroidectomy incision. A 1 cm nodule was palpated in the left side of her neck. A cervical ultrasonography (USG showed a 9 × 7 mm nodule in the remnant thyroid and a 9.5 × 3.5 mm fistulized fluid collection. The patient underwent sinus tract and remnant thyroid removal. This case report presents a cutaneous sinus formation deriving from the granulation tissue, probably due to the silk suture reaction in the previous surgery, by the FNAB guided by palpation procedure. We suggest USG guided FNAB to achieve more accurate and safe diagnosis in evaluating the thyroid nodules.

  9. Effect of a Biopsy Center on Adequacy Rates of Thyroid Nodule Fine-Needle Aspiration.

    Science.gov (United States)

    Leung, Vincent A; Kirpalani, Anish; Mnatzakanian, Gevork; Colak, Errol; Vlachou, Paraskevi A

    2017-08-01

    The purpose of this study was to investigate the effect of a biopsy center-a dedicated space with a dedicated ultrasound machine and technologist, staffed daily by a radiologist responsible for performing ultrasound-guided procedures only-on the rate of non-diagnostic or unsatisfactory thyroid fine-needle aspiration (FNA). Three radiologists performed FNA on 1200 nodules in 998 patients between September 2010 and November 2015. We compared rates of nondiagnostic or unsatisfactory FNA before and after implementation of a biopsy center in September 2014 as part of a quality improvement initiative. Before the establishment of our biopsy center, ultrasound-guided procedures were scheduled between diagnostic studies in the main ultrasound department and were performed by a radiologist responsible for both. Multivariate logistic regression analysis was performed to assess the effect of the biopsy center on the odds of obtaining an adequate sample. Rates of nondiagnostic or unsatisfactory FNA decreased significantly from 15.1% to 8.5% (p biopsy center. The odds of obtaining an adequate sample were higher in the biopsy center (odds ratio, 2.07; 95% CI, 1.43-3.01), even after adjusting for patient age, nodule size, the radiologist performing the procedure, and time over the study period. The implementation of a biopsy center was associated with significantly lower rates of nondiagnostic or unsatisfactory thyroid FNA, suggesting target rates of 10% or lower are achievable with quality improvement measures.

  10. A portable, low coherence interferometry based instrument for fine needle aspiration biopsy guidance

    Science.gov (United States)

    Iftimia, Nicusor V.; Bouma, Brett E.; Pitman, Martha B.; Goldberg, Brian; Bressner, Jason; Tearney, Guillermo J.

    2005-06-01

    A portable, low coherence interferometry (LCI) based instrument for fine-needle aspiration biopsy guidance is presented. The instrument consists of a fiber-based low coherence interferometer, a data acquisition, processing and display unit, and a probe. The probe, consisting of a 250μm diameter single-mode optical fiber inserted within the bore of a fine needle, is used to illuminate tissue and collect light from tissue at the tip of the needle. Light returning out of the probe is detected by the LCI system, which is capable of measuring depth-resolved information (reflectivity, spectra, birefringence) with a spatial resolution of 10μm over a depth range of approximately 1.4mm. The LCI based instrument can be used to guide the fine needle during biopsy procedures to potentially diagnose neoplasms, infections, inflammations, or infiltrations. The design and performance of the instrument, as well as preliminary measurements on excised breast tissue specimens, are presented in detail.

  11. A Novel Hybrid MCDM Procedure for Achieving Aspired Earned Value Project Performance

    Directory of Open Access Journals (Sweden)

    Shou-Yan Chou

    2016-01-01

    Full Text Available A better-performing project gains more subsequent businesses. Many organizations worldwide apply an earned value management (EVM system to monitor and control their projects’ performance. However, a successful EVM application requires handling multiple interinfluenced criteria with feedback effects for decision-making and continuous improvements throughout the application life cycle. The conventional decision approaches assume that preferences between criteria are independent and put their focuses on decision-making. This study employs a hybrid multiple criteria decision-making (HMCDM method to devise a novel procedure to fulfil the deficiencies. The proposed procedure enables us to evaluate interinfluence effects and gap indices among criteria/dimensions/alternatives and then systemize the evaluation results in a context of influential network relation map (INRM. The INRM provides managers with visual information to find a route in making application decisions, while identifying critical gaps for continuous improvements. A numerical example is presented to illustrate the applicability of the proposed procedure. The results show that, by employing the HMCDM method, the proposed procedure can provide organizations with a foundation to ensure that the aspired EVM application outcomes are achieved at different levels within an organization.

  12. Alterations in cancer cell mechanical properties after fluid shear stress exposure: a micropipette aspiration study

    Directory of Open Access Journals (Sweden)

    Chivukula VK

    2015-01-01

    Full Text Available Venkat Keshav Chivukula,1 Benjamin L Krog,1,2 Jones T Nauseef,2 Michael D Henry,2 Sarah C Vigmostad1 1Department of Biomedical Engineering, 2Department of Molecular Physiology and Biophysics, Holden Comprehensive Cancer Center, University of Iowa, Seamans Center for the Engineering Arts and Sciences, Iowa City, IA, USA Abstract: Over 90% of cancer deaths result not from primary tumor development, but from metastatic tumors that arise after cancer cells circulate to distal sites via the circulatory system. While it is known that metastasis is an inefficient process, the effect of hemodynamic parameters such as fluid shear stress (FSS on the viability and efficacy of metastasis is not well understood. Recent work has shown that select cancer cells may be able to survive and possibly even adapt to FSS in vitro. The current research seeks to characterize the effect of FSS on the mechanical properties of suspended cancer cells in vitro. Nontransformed prostate epithelial cells (PrEC LH and transformed prostate cancer cells (PC-3 were used in this study. The Young's modulus was determined using micropipette aspiration. We examined cells in suspension but not exposed to FSS (unsheared and immediately after exposure to high (6,400 dyn/cm2 and low (510 dyn/cm2 FSS. The PrEC LH cells were ~140% stiffer than the PC-3 cells not exposed to FSS. Post-FSS exposure, there was an increase of ~77% in Young's modulus after exposure to high FSS and a ~47% increase in Young's modulus after exposure to low FSS for the PC-3 cells. There was no significant change in the Young's modulus of PrEC LH cells post-FSS exposure. Our findings indicate that cancer cells adapt to FSS, with an increased Young's modulus being one of the adaptive responses, and that this adaptation is specific only to PC-3 cells and is not seen in PrEC LH cells. Moreover, this adaptation appears to be graded in response to the magnitude of FSS experienced by the cancer cells. This is the first study

  13. Evaluation of pediatric abdominal masses by fine-needle aspiration cytology: a clinicoradiologic approach.

    Science.gov (United States)

    Viswanathan, Seethalakshmi; George, Sophia; Ramadwar, Mukta; Medhi, Seema; Arora, Brijesh; Kurkure, Purna

    2010-01-01

    The pathologist forms a very important part of the clinical team in the management of pediatric intra-abdominal masses in giving a rapid, accurate diagnosis for these potentially curable tumors. Fine-needle aspiration cytology (FNAC) is an invaluable tool in this regard when interpreted with clinicoradiologic parameters. With this in mind, we decided to evaluate the role of FNAC in pediatric abdominal masses in our institution. A total of 83 of 105 FNAC accessioned in the pathology department over 5 years (2003-2007) were studied. These included only cases where a diagnosis could be offered on cytology. Detailed clinicoradiological features were obtained from hospital records. Cytomorphological features examined included cellularity, architectural pattern, background, key cellular details. Immunocytochemistry were done where necessary. Lesions diagnosed on FNAC included Wilms' tumor (19), lymphoma (10), neuroblastoma (6), hepatoblastoma (5), PNET (5), rhabdomyosarcoma (2), DSRCT (2), germ cell tumor (6), and miscellaneous tumors (7). Definite diagnosis could be offered on cytomorphology in 74.7% (62) cases, while in 25.3% (21) cases only a diagnosis of round cell tumor could be offered. Concordance with final histopathology and biochemical parameters was subsequently obtained in 79/83 (95.5%) of cases. A clinically relevant classification is possible on FNAC in pediatric abdominal tumors when interpreted with clinicoradiologic parameters. This obviates the need for a more time-consuming biopsy procedure in critical situations and in stage II nephroblastoma where it is contraindicated. (c) 2009 Wiley-Liss, Inc.

  14. The effect of gender on medical students' aspirations: a qualitative study.

    Science.gov (United States)

    Drinkwater, Jess; Tully, Mary Patricia; Dornan, Tim

    2008-04-01

    This study aimed to explore the effect of gender on medical students' aspirations. The study design included purposive sampling and interim data interpretation to guide recruitment of medical students with a wide spectrum of opinions. Data were collected through audio-recorded, semi-structured, in-depth exploratory interviews, which were transcribed verbatim. Qualitative analysis was carried out by a female medical student researcher. Her evolving interpretation was constantly compared against the original data by male (doctor) and female (pharmacist) staff researchers in a systematic search for internal corroboration or disconfirmation. Causal associations consistently present in the data are reported. Six male and six female medical students in Years 3 and 4 shared a wish to achieve a work-life balance that allowed them to devote time to bringing up children while contributing usefully to society as doctors. However, women were readier to compromise professional attainment within their personal work-life balances. Their readiness derived from gendered stereotypes of women's social and professional roles, a lack of female professional role models, womens' greater awareness of the tensions between career and family, various other informal social influences, and a lack of positive career advice to counterbalance these influences. Better career advice and more flexible work opportunities are needed if the two-thirds of medical students who are women are to contribute specialist as well as generalist expertise to the medical workforce.

  15. Endometrial aspiration cytology in gynecological disorders

    OpenAIRE

    Jadhav, Meenal V.; Anjali S Phatke; Nalini Vinayak Kadgi; Sharda R Rane; Kulkarni, Kalpana K.

    2016-01-01

    Context: Endometrial aspiration is not a popular modality for the study of the endometrium despite its simplicity and potential utility. Aim: The present study was aimed at evaluating the utility of endometrial aspiration in various gynecological disorders. Materials and Methods: In this diagnostic accuracy study, 55 prospectively registered women with various gynecological disorders were evaluated clinically and subjected to endometrial aspiration cytology and study of endometrial histo...

  16. Hyalinizing trabecular tumor of the thyroid gland: A puzzling entity on fine needle aspiration cytology

    Directory of Open Access Journals (Sweden)

    Jitendra Nasit

    2014-01-01

    Full Text Available Hyalinizing trabecular tumor (HTT is a rare unique but controversial thyroid neoplasm, characterized by prominent trabecular growth pattern and stromal hyalinization. Whether HTT is a benign tumor or a variant of papillary thyroid carcinoma (PTC is still unclear. Cytology findings of HTT have been described in few reports. Cytological features of HTT frequently overlap with those of PTC and medullary thyroid carcinoma, which can lead to frequent misdiagnosis. In order to avoid overtreatment like total thyroidectomy, pathologist should be aware of cytological features of HTT. We present a case of 35-year-old female with a right-side thyroid swelling for three years. Fine needle aspiration cytology was performed. According to The Bethesda System for Reporting Thyroid Cytopathology, cytological diagnosis of benign thyroid neoplasm was made. Histopathology of the right thyroidectomy specimen showed HTT. Accurate preoperative diagnosis of HTT requires a very meticulous and cautious approach in the evaluation of cytological features. Trabecular pattern of cells, vague curved nuclear palisading, radiating arrangement of cells around hyaline material, spindled to elongated cells, filamentous cytoplasmic processes with ill-defined cell border and yellow bodies are important diagnostic features of HTT. Nuclear features alone are insufficient for the diagnosis of HTT. Any suspicious cytology of thyroid lesion should follow hemithyroidectomy and histopathological evaluation.

  17. Pancreatic metastasis in a case of small cell lung carcinoma: Diagnostic role of fine-needle aspiration cytology and immunocytochemistry

    Directory of Open Access Journals (Sweden)

    Dilip K Das

    2011-01-01

    Full Text Available Small cell lung carcinoma represents a group of highly malignant tumors giving rise to early and widespread metastasis at the time of diagnosis. However, the pancreas is a relatively infrequent site of metastasis by this neoplasm, and there are only occasional reports on its fine needle aspiration (FNA cytology diagnosis. A 66-year-old man presented with extensive mediastinal lymphadenopathy and a mass in the pancreatic tail. Ultrasound-guided FNA smears from the pancreatic mass contained small, round tumor cells with extensive nuclear molding. The cytodiagnosis was metastatic small cell carcinoma. Immunocytochemical staining showed that a variable number of neoplastic cell were positive for cytokeratin, chromogranin A, neurone-specific enolase and synaptophysin but negative for leukocyte common antigen. The trans-bronchial needle aspiration was non-diagnostic, but biopsy was suspicious of a small cell carcinoma. This case represents a rare metastatic lesion in the pancreas from small cell lung carcinoma, diagnosed by FNA cytology.

  18. Application of frameless stereotactic aspiration in the treatment of hypertension cerebral hemorrhage

    Directory of Open Access Journals (Sweden)

    You-san ZHANG

    2016-09-01

    Full Text Available Objective  To investigate the technical points and clinical outcomes of frameless stereotactic aspiration in treatment of patients with hypertension cerebral hemorrhage (HPCH. Methods  The clinical data of 68 consecutive patients with HPCH, treated with frameless stereotactic aspiration from Jan. 2012 to Jun. 2014, were retrospectively analyzed, and compared to that of 45 patients treated in the meantime by frame-based stereotactic aspiration. The surgical results, procedure-related complications and clinical prognosis were evaluated. Results  For the patients treated with frameless stereotactic aspiration, the median age was 53.3 years (range 36-80, the mean initial Glasgow coma scale score was over 5. Among them seven patients died within a month after operation: 3 died of respiratory failure, 2 of cerebral edema and 2 of rehemorrhage. At the six-months follow-up, the good recovery rate (gradeⅠ-Ⅲof ADL was 77.9%(53/68, better than that of patients treated with frame-based stereotactic aspiration (60.0%, P<0.05. Conclusion  Frameless stereotactic aspiration for HPCH is easy to operate, minimal invasion and safe procedure with low mortality and rehemorrhage rate. DOI: 10.11855/j.issn.0577-7402.2016.08.12

  19. A qualitative study of the aspirations and challenges of low-income mothers in feeding their preschool-aged children

    Directory of Open Access Journals (Sweden)

    Herman Allison N

    2012-11-01

    Full Text Available Abstract Background The prevalence of obesity among preschool-aged children has increased, especially among those in low-income households. Two promising behavioral targets for preventing obesity include limiting children’s portion sizes and their intake of foods high in solid fats and/or added sugars, but these approaches have not been studied in low-income preschoolers in the home setting. The purpose of this study was to understand the contextual factors that might influence how low-income mothers felt about addressing these behavioral targets and mothers’ aspirations in feeding their children. Methods We recruited 32 English-speaking women in Philadelphia, Pennsylvania who were eligible for the Supplemental Nutrition Assistance Program and who were the biologic mothers of children 36 to 66 months of age. Each mother participated in 1 of 7 focus groups and completed a brief socio-demographic questionnaire. Focus group questions centered on eating occasions, foods and drinks consumed in the home, and portion sizes. Each focus group lasted 90 minutes and was digitally recorded and transcribed verbatim. Three authors independently identified key themes and supporting quotations. Themes were condensed and modified through discussion among all authors. Results Thirty-one mothers identified themselves as black, 15 had a high school education or less, and 22 lived with another adult. Six themes emerged, with three about aspirations mothers held in feeding their children and three about challenges to achieving these aspirations. Mothers’ aspirations were to: 1 prevent hyperactivity and tooth decay by limiting children’s sugar intake, 2 use feeding to teach their children life lessons about limit setting and structure, and 3 be responsive to children during mealtimes to guide decisions about portions. Especially around setting limits with sweets and snacks, mothers faced the challenges of: 1 being nagged by children’s food requests, 2 being

  20. Testicular fine needle aspiration as a diagnostic tool in non-obstructive azoospermia

    Institute of Scientific and Technical Information of China (English)

    A. Bettella; A. Ferlin; M. Menegazzo; M. Ferigo; I. M. Tavolini; P. F. Bassi; C. Foresta

    2005-01-01

    Aim: To report the fine needle aspiration cytology (FNAC) of the testes used as a diagnostic tool in non-obstructive azoospermic patients. Methods: One hundred and twenty-five non-obstructive azoospermic male candidates to intracytoplasmic sperm injetion (ICSI) were analysed for follicle stimulating hormone (FSH), luteinizing hormone (LH), testosterone and inhibin B plasma levels. They were classified into three groups on the basis of FNAC: 1) Sertoli cell-only syndrome (SCOS) (70); 2) severe hypospermatogenesis (42); and 3) maturation arrest (13). Then, all men underwent testicular sperm extraction (TESE) for sperm recovery for ICSI. Results: Mature spermatozoa were detected by FNAC in 24 of 42 men with severe hypospermatogenesis and nine of 13 men with maturation arrest;while they were retrieved by TESE in 29 of 70 men with SCOS, 35 of 42 men with severe hypospermatogenesis (including the 24 by FNAC) and 10 of 13 men with maturation arrest (including the nine by FNAC). The sensitivity and specificity of FNAC were 44.6 % and 100 %, respectively. There was no difference on testicular volume and hormonal parameters in men with and without sperm retrieved. Conclusion: These findings suggest that FNAC may be a simple and valid diagnostic parameter in non-obstructive azoospermic men and it may represent a valid positive prognostic parameter for sperm recovery at TESE.

  1. Propofol and remifentanil for rapid sequence intubation in a pediatric patient at risk for aspiration with elevated intracranial pressure.

    Science.gov (United States)

    Dewhirst, Elisabeth; Tobias, Joseph D; Martin, David P

    2013-11-01

    Aspiration is a significant cause of anesthetic morbidity, occurring most commonly during the induction of anesthesia. For patients with a high likelihood of aspiration, rapid sequence intubation (RSI) techniques may minimize this risk by reducing the time between the loss of protective airway reflexes and the placement of a cuffed endotracheal tube. Although RSI frequently involves the administration of a neuromuscular-blocking agent (NMBA) such as succinylcholine or rocuronium, there are times when the administration of an NMBA is contraindicated or undesirable. We present an 11-year-old boy who presented with vomiting, papilledema, and a history concerning for an undiagnosed neuromuscular disorder. Deep sedation or anesthesia was required during an emergent lumbar puncture to evaluate his symptoms. Rapid sequence intubation was successfully performed with propofol and remifentanil without the use of an NMBA. We highlight the anesthetic considerations in such a clinical scenario and review the literature regarding the combination of remifentanil and propofol for RSI.

  2. Endoscopic ultrasound-guided fine-needle aspiration for thediagnosis of kidney lesions: A review

    Institute of Scientific and Technical Information of China (English)

    Roberto Iglesias Lopes; Renata Nobre Moura; Everson Artifon

    2015-01-01

    Traditionally, treatment of renal lesions is indicatedbased only on imaging features. Although controversyexists about tissue sampling from small renalmasses, renal biopsy is indicated in some cases. Inthis review, we discuss the rationale for endoscopicultrasound-guided fine needle aspiration (EUS-FNA) andsummarize the recent advances in this field, providingrecommendations for the practicing clinician. The useof EUS-FNA appears to be a safe and feasible meansof confirming or excluding malignancy. EUS allowsassessment and biopsy of masses or lesions withinboth kidneys and related complications are rare. Themain advantages of EUS-FNA are that it can be doneas an outpatient procedure, with good results, minimalmorbidity and a short hospital stay. Nevertheless,EUS-FNA of renal masses should be indicated only inselected cases, in which there is potential to decreaseunnecessary treatment of small renal masses and tobest select tumors for active surveillance and minimallyinvasive ablative therapies. Additionally, some renallesions may be ineligible for EUS-guided biopsy becauseof anatomical limitations. EUS-FNA renal biopsy willprobably be best applied to central anterior renalmasses, while tumors on the posterior aspect of thekidney, percutaneous access will probably be superior.

  3. [Fine needle aspiration cytology of mammography screening

    DEFF Research Database (Denmark)

    Engvad, B.; Laenkholm, A.V.; Schwartz, Thue W.

    2009-01-01

    INTRODUCTION: In the year 2000 a quality assurance programme for the preoperative breast diagnostics was introduced in Denmark. The programme was based on the "European guidelines for quality assurance in breast cancer screening and diagnosis" where - among other measures - five cytological...... diagnostic classes were introduced. The aim of this study was to evaluate the quality assurance programme in a screening population to determine whether fine needle aspiration cytology (FNAC) as first choice remains a useful tool in the preoperative diagnostics, or if needle core biopsy should be the first...... of 66% of the 783 FNACs had a malignant cytology diagnosis, which in 99% of the cases turned out to be the correct diagnosis. Four lesions were false positives all of which represented benign proliferative breast diseases. The surgical procedures in these cases were either excisional biopsy...

  4. Pleomorphic rhabdomyosarcoma of the heart metastatic to bone. Report of a case with fine needle aspiration biopsy findings.

    Science.gov (United States)

    Ali, S Z; Smilari, T F; Teichberg, S; Hajdu, S I

    1995-01-01

    Pleomorphic rhabdomyosarcoma is an extremely rare and highly malignant neoplasm. We report an unusual case of a 14-year-old boy with skeletal metastases from a primary cardiac tumor. Fine needle aspiration biopsy of a lytic lesion in the right iliac wing showed a pleomorphic population of clusters and single cells with hyperchromatic nuclei; granular, pink cytoplasm; and isolated, large cells with whiplike or globoid cytoplasmic processes and occasional striations. Histologic, ultrastructural and radiologic features are also presented.

  5. Surgical Treatment of a Large Complex Odontoma

    Directory of Open Access Journals (Sweden)

    Burak Cezairli

    2017-08-01

    Full Text Available The treatment modalities for odontomas are generally depend on the tumors size. Small and medium lesions can usually be removed easily allowing preservation of surrounding anatomical structures. In our study, we reported a conservative surgical treatment of a large complex odontoma. A 19-year-old woman was referred to our clinic after an incidentally observed lesion on her right mandibular angle. The patient was symptom-free at the time of visit. Computed tomography (CT images showed a mass with a size of 3.5 cm x 3 cm x 2 cm. CT sections and tridimensional images showed partially eroded buccal and lingual cortex. Surgical treatment was indicated with an initial diagnosis of compound odontoma. The lesion removed after sectioning with bur and maxillo-mandibular fixation (MMF were not thought to be necessary while the buccal and lingual cortexes were mostly reliable for preventing a fracture. In our case, the size of the odontoma was suitable for a conservative treatment method and with this modality we managed to prevent a possible fracture and eliminate the disadvantages of MMF.

  6. Fine-needle aspiration of the thyroid: an overview

    Directory of Open Access Journals (Sweden)

    Nguyen Gia-Khanh

    2005-06-01

    Full Text Available Abstract Thyroid nodules (TN are a common clinical problem. Fine needle aspiration (FNA of the thyroid now is practiced worldwide and proves to be the most economical and reliable diagnostic procedure to identify TNs that need surgical excision and TNs that can be managed conservatively. The key for the success of thyroid FNA consists of an adequate or representative cell sample and the expertise in thyroid cytology. The FNA cytologic manifestations of TNs may be classified into seven working cytodiagnostic groups consisting of a few heterogenous lesions each to facilitate the differential diagnosis. Recent application of diagnostic molecular techniques to aspirated thyroid cells proved to be useful in separating benign from malignant TNs in several cases of indeterminate lesions.

  7. Papillary thyroid carcinoma, a diagnostic approach in fine needle aspiration: Review of literature

    Directory of Open Access Journals (Sweden)

    Shirish S Chandanwale

    2013-01-01

    Full Text Available Background: Despite well-defined cytology features of papillary thyroid carcinoma (PTC in fine needle aspiration (FNA, diagnostic difficulties do exist while making decision in respect to papillary thyroid carcinoma (PTC cases. Aims: The aim of this study is to clarify diagnostic significance of various cytology features of PTC and to identify possible diagnostic pitfalls. Materials and Methods: FNA cytology (FNAC features and clinical findings of 17 PTC cases diagnosed on histology were retrieved. A retrospective review of these cases was performed. Results: The frequency and number of papillary formations, intranuclear cytoplasmic inclusions (INCI, and nuclear grooves (NG was more in PTC cases as compared to suggestive/suspicious of (S/O and rule out (R/O PTC cases. Cyst macrophages forming clusters were seen in six cases. Multinucleated giant cells (MGC were seen in seven cases. Large MGC with dense cytoplasm and more nuclei were seen in four PTC and one S/O PTC cases. Conclusion: FNAC features of PTC in FNA smears are neither constant nor specific. All the cytology features of PTC should be reported in proper context which allows endocrine specialist to treat and urgent histological verification.

  8. Diagnosis of Langerhans Cell Histiocytosis on Fine Needle Aspiration Cytology: A Case Report and Review of the Cytology Literature

    Directory of Open Access Journals (Sweden)

    Neeta Kumar

    2011-01-01

    Full Text Available A case of multifocal Langerhans cell histiocytosis in a two-year-old child is presented where fine needle aspiration was helpful in achieving a rapid and accurate diagnosis in an appropriate clinical and radiological setting. This can avoid unnecessary biopsy and guide the management especially where access to histopathology is limited. The highly characteristic common and rare cytological features are highlighted with focus on differential diagnoses and causes of pitfalls.

  9. A Literature Review of Renal Surgical Anatomy and Surgical Strategies for Partial Nephrectomy

    Science.gov (United States)

    Klatte, Tobias; Ficarra, Vincenzo; Gratzke, Christian; Kaouk, Jihad; Kutikov, Alexander; Macchi, Veronica; Mottrie, Alexandre; Porpiglia, Francesco; Porter, James; Rogers, Craig G.; Russo, Paul; Thompson, R. Houston; Uzzo, Robert G.; Wood, Christopher G.; Gill, Inderbir S.

    2016-01-01

    Context A detailed understanding of renal surgical anatomy is necessary to optimize preoperative planning and operative technique and provide a basis for improved outcomes. Objective To evaluate the literature regarding pertinent surgical anatomy of the kidney and related structures, nephrometry scoring systems, and current surgical strategies for partial nephrectomy (PN). Evidence acquisition A literature review was conducted. Evidence synthesis Surgical renal anatomy fundamentally impacts PN surgery. The renal artery divides into anterior and posterior divisions, from which approximately five segmental terminal arteries originate. The renal veins are not terminal. Variations in the vascular and lymphatic channels are common; thus, concurrent lymphadenectomy is not routinely indicated during PN for cT1 renal masses in the setting of clinically negative lymph nodes. Renal-protocol contrast-enhanced computed tomography or magnetic resonance imaging is used for standard imaging. Anatomy-based nephrometry scoring systems allow standardized academic reporting of tumor characteristics and predict PN outcomes (complications, remnant function, possibly histology). Anatomy-based novel surgical approaches may reduce ischemic time during PN; these include early unclamping, segmental clamping, tumor-specific clamping (zero ischemia), and unclamped PN. Cancer cure after PN relies on complete resection, which can be achieved by thin margins. Post-PN renal function is impacted by kidney quality, remnant quantity, and ischemia type and duration. Conclusions Surgical renal anatomy underpins imaging, nephrometry scoring systems, and vascular control techniques that reduce global renal ischemia and may impact post-PN function. A contemporary ideal PN excises the tumor with a thin negative margin, delicately secures the tumor bed to maximize vascularized remnant parenchyma, and minimizes global ischemia to the renal remnant with minimal complications. Patient summary In this report

  10. Thrombus aspiration during primary percutaneous coronary intervention for acute myocardial infarction:A review of clinical evidence and guidelines

    Institute of Scientific and Technical Information of China (English)

    Muhammad Muzaffar Mahmood; Jonathan Watt; Javed M Ahmed

    2015-01-01

    Acute ST segment elevation myocardial infarction(STEMI) is characterized by complete thrombotic occlusion of a major coronary artery. Early recanalization of the infarct-related artery is most efficiently delivered by primary percutaneous coronary intervention(PPCI),however this does not always restore normal myocardial perfusion,mainly due to distal embolization of the thrombus and microvascular obstruction. Early evidence for manual thrombus aspiration during PPCI was promising and this was once considered an important aspect of the procedure,especially in patients with a high thrombus burden. However,a large body of evidence from recent major randomized controlled trials(notably TASTE and TOTAL) does not support the routine use of manual thrombus aspiration in patients with STEMI undergoing PPCI.

  11. Instituting a Surgical Skills Competition Increases Technical Performance of Surgical Clerkship Students Over Time.

    Science.gov (United States)

    Leraas, Harold J; Cox, Morgan L; Bendersky, Victoria A; Sprinkle, Shanna S; Gilmore, Brian F; Gunasingha, Rathnayaka M; Tracy, Elisabeth T; Sudan, Ranjan

    2017-10-04

    Surgical skills training varies greatly between institutions and is often left to students to approach independently. Although many studies have examined single interventions of skills training, no data currently exists about the implementation of surgical skills assessment as a component of the medical student surgical curriculum. We created a technical skills competition and evaluated its effect on student surgical skill development. Second-year medical students enrolled in the surgery clerkship voluntarily participated in a surgical skills competition consisting of knot tying, laparoscopic peg transfer, and laparoscopic pattern cut. Winning students were awarded dinner with the chair of surgery and a resident of their choice. Individual event times and combined times were recorded and compared for students who completed without disqualification. Disqualification included compromising cutting pattern, dropping a peg out of the field of vision, and incorrect knot tying technique. Timed performance was compared for 2 subsequent academic years using Mann-Whitney U test. Overall, 175 students competed and 71 students met qualification criteria. When compared by academic year, 2015 to 2016 students (n = 34) performed better than 2014 to 2015 students (n = 37) in pattern cut (133s vs 167s, p = 0.040), peg transfer (66s vs 101s, p skills competition improves student technical performance. Further research is needed regarding long-term benefits of surgical competitions for medical students. Copyright © 2017 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

  12. Percutaneous aspiration of fluid for management of peritonitis in space

    Science.gov (United States)

    Kirkpatrick, A. W.; Nicolaou, S.; Campbell, M. R.; Sargsyan, A. E.; Dulchavsky, S. A.; Melton, S.; Beck, G.; Dawson, D. L.; Billica, R. D.; Johnston, S. L.; Hamilton, D. R.

    2002-01-01

    BACKGROUND: As a medical emergency that can affect even well-screened, healthy individuals, peritonitis developing during a long-duration space exploration mission may dictate deviation from traditional clinical practice due to the absence of otherwise indicated surgical capabilities. Medical management can treat many intra-abdominal processes, but treatment failures are inevitable. In these circumstances, percutaneous aspiration under sonographic guidance could provide a "rescue" strategy. Hypothesis: Sonographically guided percutaneous aspiration of intra-peritoneal fluid can be performed in microgravity. METHODS: Investigations were conducted in the microgravity environment of NASA's KC-135 research aircraft (0 G). The subjects were anesthetized female Yorkshire pigs weighing 50 kg. The procedures were rehearsed in a terrestrial animal lab (1 G). Colored saline (500 mL) was introduced through an intra-peritoneal catheter during flight. A high-definition ultrasound system (HDI-5000, ATL, Bothell, WA) was used to guide a 16-gauge needle into the peritoneal cavity to aspirate fluid. RESULTS: Intra-peritoneal fluid collections were easily identified, distinct from surrounding viscera, and on occasion became more obvious during weightless conditions. Subjectively, with adequate restraint of the subject and operators, the procedure was no more demanding than during the 1-G rehearsals. CONCLUSIONS: Sonographically guided percutaneous aspiration of intra-peritoneal fluid collections is feasible in weightlessness. Treatment of intra-abdominal inflammatory conditions in spaceflight might rely on pharmacological options, backed by sonographically guided percutaneous aspiration for the "rescue" of treatment failures. While this risk mitigation strategy cannot guarantee success, it may be the most practical option given severe resource limitations.

  13. A simple technique to restore needle patency during percutaneous lavage and aspiration of calcific rotator cuff tendinopathy.

    Science.gov (United States)

    Jelsing, Elena J; Maida, Eugene; Smith, Jay

    2013-03-01

    Calcific rotator cuff tendinopathy caused by symptomatic calcium hydroxyapatite crystal deposition is a well-established cause of shoulder pain. In refractory or acutely symptomatic cases, sonographically guided percutaneous lavage and aspiration can significantly reduce pain in approximately 60%-92% of cases. Although the complication rate of sonographically guided percutaneous lavage and aspiration is apparently low, needle clogging attributable to impacted calcific debris has been described by several authors and in our experience can occur in daily practice. Traditionally, an inability to relieve the obstruction via needle repositioning or increased syringe plunger pressure has required needle removal and replacement. In this article, we outline a simple technique that can be used to restore patency of the obstructed lavage needle without necessitating needle removal and replacement.

  14. Facial plexiform neurofibromatosis: A surgical challenge

    Directory of Open Access Journals (Sweden)

    Bharat B Dogra

    2013-01-01

    Full Text Available Plexiform neurofibromatosis is a relatively common but potentially devastating manifestation of neurofibromatosis type 1 (NF1. It produces very hideous deformity if the face is involved. Surgical management remains the mainstay of therapy, but in the head and neck region it is limited by the infiltrating nature of these tumors, inherent operative morbidity and high rate of regrowth. We present two cases of facial neurofibromatosis managed in our hospital. The first patient presented with overhanging mass of skin folds on the right side of her face, completely obliterating her right eye. The other patient was a young male having a huge, unsightly swelling over the right cheek, resulting in pulled down right eyelids and right pinna. Physical examination revealed the presence of café au lait macules, freckling in the axillary region and multiple neurofibromas over the trunk. Reconstructive surgical procedure in the form of subtotal excision of tumor mass followed by re draping of the facial skin was performed in both cases. There was evidence of regrowth of the tumor on review after 6 months.

  15. Factors involved in the discontinuation of oral intake in elderly patients with recurrent aspiration pneumonia: a multicenter study

    Science.gov (United States)

    Kenzaka, Tsuneaki; Takeshima, Taro; Kosami, Koki; Kumabe, Ayako; Ueda, Yuki; Takahashi, Takeshi; Yamamoto, Yuya; Hayashi, Yurika; Kitao, Akihito; Okayama, Masanobu

    2017-01-01

    Purpose To assess the factors involved in oral intake discontinuation in elderly patients with recurrent aspiration pneumonia. Patients and methods This study included patients with pneumonia who were treated at Jichi Medical University Hospital between 2007 and 2013, at Toyooka Public Hospital between 2011 and 2013 and at Yuzawa Community Medical Center between 2010 and 2012. We consecutively enrolled patients with aspiration pneumonia. The primary study point was oral intake discontinuation after the initiation of oral intake during hospitalization in cases of recurrent aspiration. Various parameters were recorded at admission, at the initiation of intake, and during hospitalization; these parameters were statistically evaluated. Results A total of 390 patients were assigned to either a “no reaspiration of intake” group (n=310) or a “reaspiration of intake” group (n=80), depending on whether intake was discontinued owing to aspiration during hospitalization. At admission, the following items significantly differed between the groups: level of consciousness, respiratory rate, oxygen saturation, CURB-65 score, extent of infiltration/opacity on chest radiography, albumin levels, blood urea nitrogen levels, and application of swallowing function assessment. At the initiation of intake, level of consciousness, pulse rate, and albumin levels significantly differed between the groups. The following items did not significantly differ between groups: systolic blood pressure, pulse rate, C-reactive protein, bacteremia, use of ventilator at admission, oxygen administration, respiratory rate, and systolic blood pressure at initiation of intake. Multivariate analysis revealed that application of swallowing function assessment, level of consciousness at the initiation of intake, and extent of infiltration/opacity on chest radiography were significant predictive variables for discontinuation of intake. Conclusion A low level of consciousness at the initiation of intake

  16. SHOX2 DNA Methylation is a Biomarker for the diagnosis of lung cancer based on bronchial aspirates

    Directory of Open Access Journals (Sweden)

    Liloglou Triantafillos

    2010-11-01

    Full Text Available Abstract Background This study aimed to show that SHOX2 DNA methylation is a tumor marker in patients with suspected lung cancer by using bronchial fluid aspirated during bronchoscopy. Such a biomarker would be clinically valuable, especially when, following the first bronchoscopy, a final diagnosis cannot be established by histology or cytology. A test with a low false positive rate can reduce the need for further invasive and costly procedures and ensure early treatment. Methods Marker discovery was carried out by differential methylation hybridization (DMH and real-time PCR. The real-time PCR based HeavyMethyl technology was used for quantitative analysis of DNA methylation of SHOX2 using bronchial aspirates from two clinical centres in a case-control study. Fresh-frozen and Saccomanno-fixed samples were used to show the tumor marker performance in different sample types of clinical relevance. Results Valid measurements were obtained from a total of 523 patient samples (242 controls, 281 cases. DNA methylation of SHOX2 allowed to distinguish between malignant and benign lung disease, i.e. abscesses, infections, obstructive lung diseases, sarcoidosis, scleroderma, stenoses, at high specificity (68% sensitivity [95% CI 62-73%], 95% specificity [95% CI 91-97%]. Conclusions Hypermethylation of SHOX2 in bronchial aspirates appears to be a clinically useful tumor marker for identifying subjects with lung carcinoma, especially if histological and cytological findings after bronchoscopy are ambiguous.

  17. The Morality of Aspiration: A Neglected Dimension of Law and Morality

    NARCIS (Netherlands)

    W. van der Burg (Wibren)

    1999-01-01

    markdownabstractIntroduction In The Morality of Law, Fuller introduces the distinction between the morality of duty and the morality of aspiration, and applies it to problems of jurisprudence. 1 In moral theory, both types of morality may be easily associated (though never completely

  18. The Morality of Aspiration: A Neglected Dimension of Law and Morality

    NARCIS (Netherlands)

    W. van der Burg (Wibren)

    1999-01-01

    markdownabstractIntroduction In The Morality of Law, Fuller introduces the distinction between the morality of duty and the morality of aspiration, and applies it to problems of jurisprudence. 1 In moral theory, both types of morality may be easily associated (though never completely identified) w

  19. A technique to improve diagnostic information from fine-needle aspirations: immunohistochemistry on cytoscrape

    DEFF Research Database (Denmark)

    Skov, Birgit Guldhammer; Kiss, Katalin; Ramsted, Julie

    2009-01-01

    BACKGROUND: Cytologic examination of fine-needle aspiration (FNA) material is being used increasingly for the diagnosis of pulmonary lesions. Accurate distinction between nonsmall cell lung cancer (NSCLC), including subgroups, and small cell lung cancer and between primary lung cancer and metasta...

  20. Endometrial aspiration biopsy: a non-invasive method of obtaining functional lymphoid progenitor cells and mature natural killer cells.

    LENUS (Irish Health Repository)

    McMenamin, Moya

    2012-09-01

    The aim of this study was to compare the efficacy of endometrial aspiration biopsy (EAB) with the more traditional dilatation and curettage (D&C) for the procurement of lymphoid progenitor cells and uterine natural killer (NK) populations in endometrial tissue. This prospective observational study conducted in a tertiary referral university hospital examined endometrium obtained from 32 women admitted for laparoscopic gynaecological procedures. Each participant had endometrium sampled using both EAB and D&C. Both methods were assessed as a source of uterine NK and lymphoid progenitor cells. Similar proportions of mature CD45+CD56+ NK cells (range 25.4-36.2%) and CD45+CD34+ lymphoid progenitors (range 1.2-2.0%) were found in tissue obtained using both EAB and D&C. These cells were adequate for flow cytometric analysis, magnetic bead separation and culture. Colony formation by the CD34+ population demonstrated maturational potential. Tissues obtained via endometrial biopsy and D&C are equivalent, by analysis of uterine NK and lymphoid progenitor cells. The aim of this study was to compare two methods of endometrial sampling - endometrial aspiration biopsy and traditional dilatation and curettage - for the procurement of haematopoietic stem cells and uterine natural killer (NK) populations in endometrial tissue. Thirty-two women who had gynaecological procedures in a tertiary referral hospital participated in this study and had endometrial tissue collected via both methods. Similar populations of mature NK cells and haematopoietic stem cells were found in tissue obtained using both endometrial aspiration biopsy and dilatation and curettage. Tissue obtained via endometrial aspiration biopsy was adequate for the culture and growth of haematopoietic stem cells. We conclude that tissue obtained via endometrial biopsy and dilatation and curettage is equivalent, by analysis of uterine NK and haematopoietic stem cells using flow cytometry. This has implications for further

  1. Extramedullary plasmacytoma of thyroid - a mimicker of medullary carcinoma at fine needle aspiration cytology: A case report

    Directory of Open Access Journals (Sweden)

    Vidya Bhat

    2014-01-01

    Full Text Available A rare case of extra medullary plasmacytoma (EMP of thyroid gland in a 60 year old male, occurring against a background of Hashimoto′s thyroiditis is reported. The fine needle aspiration cytology (FNAC initially done as an outpatient procedure, showed atypical epithelial cells on a background of amyloid. Considering these findings we gave a diagnosis of medullary carcinoma. Histology of the total thyroidectomy specimen showed an extensive infiltration of neoplastic plasma cells against a background of Hashimoto′s thyroiditis, with a bizarre Hurthle cell change. Immunohistochemistry on the histology sections confirmed the diagnosis of solitary plasmacytoma of thyroid against a background of Hashimoto′s thyroiditis.

  2. Ultrasonographic, Surgical, and Histopathological Findings of a Uterine Leiomyoma in a Cow

    Directory of Open Access Journals (Sweden)

    Arvind Sharma

    2012-01-01

    Full Text Available The objective of this case report was to describe the ultrasonographic, surgical, and histopathological findings of a rare clinical case of uterine leiomyoma in a 5-year-old Holstein crossbred cow presented for diagnosis and treatment of infertility. Transrectal palpation revealed a large nonpainful mass suspected to be an abscess or a tumor in the caudal abdomen on the right side. Transabdominal ultrasonography revealed a round mass with irregular hypoechogenic/echogenic foci and a thin echogenic capsule around it. Ultrasonographic-guided centesis of the lesion under local analgesia did not yield any foul smelling aspirate leading to a tentative diagnosis of an intra-abdominal tumor. The lesion was later confirmed by exploratory laparotomy and histopathology as a case of uterine leiomyoma. The cow gave birth to a live normal calf 12 months following the surgery. Rectal examination after parturition revealed no evidence of the tumor at the surgical site. Ultrasonography enabled prompt, noninvasive diagnosis of uterine leiomyoma and proved to be a useful decision-making tool in the abdominal surgery of the cow. This is an interesting case which broadens the spectrum of the causes of infertility in cattle.

  3. Fine Needle Aspiration Cytology of Pediatric Thyroid Nodules

    Directory of Open Access Journals (Sweden)

    Ayper KAÇAR

    2010-05-01

    Full Text Available Objective: The objectives were to evaluate fine needle aspiration cytology results of 39 pediatric patients, and the pathologies that cause childhood thyroid nodules, and to review the literature on the subject.Material and Method: Thyroid fine needle aspiration cytology results of 39 pediatric patients were retrospectively reviewed. Associated diseases, thyroid functions, anti-thyroid antibody levels, ultrasonographic findings and number of nodules were also evaluated.Results: The vast majority of patients with thyroid nodules were cytopathologically diagnosed as benign (97.3%. Of these patients, 64.8% (24 patients were diagnosed as nodular goiter and 35.2% (13 patients as lymphocytic thyroiditis. Thyroid malignancy was found in two patients; one was diagnosed as follicular neoplasm/ minimal invasive follicular carcinoma on surgical evaluation while the other was a secondary tumor (Burkitt's lymphoma. The majority of our subjects were females (66.6%: the female/male ratio was 2:1 for nodular goiter and 3.3:1 for thyroiditis. Surgical resection was performed in 5 patients (4 cases of nodular goiter, 1 suspicious for malignancy and cytological diagnoses were confirmed by histology.Conclusion: Our study confirmed the utility of fine needle aspiration cytology in childhood thyroid disorders along with a possible higher incidence of nodular thyroiditis in childhood. Nodular autoimmune thyroiditis, focal thyroiditis and thyroid cancer in children are discussed and attention is drawn to some special subtypes of thyroid cancer and some benign lesions that can cause difficulty in interpreting fine needle aspiration cytology and frozen sections at this age.

  4. Aspiration of biological viscoelastic drops

    CERN Document Server

    Guevorkian, Karine; Durth, Mélanie; Dufour, Sylvie; Brochard-Wyart, Françoise

    2010-01-01

    Spherical cellular aggregates are in vitro systems to study the physical and biophysical properties of tissues. We present a novel approach to characterize the mechanical properties of cellular aggregates using micropipette aspiration technique. We observe an aspiration in two distinct regimes, a fast elastic deformation followed by a viscous flow. We develop a model based on this viscoelastic behavior to deduce the surface tension, viscosity, and elastic modulus. A major result is the increase of the surface tension with the applied force, interpreted as an effect of cellular mechanosensing.

  5. Provision of general paediatric surgical services in a regional hospital.

    LENUS (Irish Health Repository)

    Zgraj, O

    2012-01-31

    BACKGROUND: In Ireland, specialist paediatric surgery is carried out in paediatric hospitals in Dublin. General surgeons\\/consultants in other surgical specialities provide paediatric surgical care in regional centres. There has been a failure to train general surgeons with paediatric skills to replace these surgeons upon retirement. AIM: To assess paediatric surgical workload in one regional centre to focus the debate regarding the future provision of general paediatric surgery in Ireland. METHODS: Hospital in-patient enquiry (HIPE) system was used to identify total number of paediatric surgical admissions and procedures. Cases assessed requiring hospital transfer. RESULTS: Of 17,478 surgical patients treated, 2,584 (14.8%) were under 14 years. A total of 2,154 procedures were performed. CONCLUSION: Regional centres without dedicated paediatric surgeons deliver care to large numbers of paediatric patients. The demand for care highlights the need for formal paediatric services\\/appropriate surgical training for general surgical trainees.

  6. A quantitative method for detecting deposits of amyloid A protein in aspirated fat tissue of patients with arthritis

    OpenAIRE

    Hazenberg, B.; Limburg, P; Bijzet, J.; VAN RIJSWIJK, M. H

    1999-01-01

    OBJECTIVE—To describe a new, quantitative, and reproducible method for detecting deposits of amyloid A protein in aspirated fat tissue and to compare it with smears stained with Congo red.
METHODS—After extraction of at least 30 mg of abdominal fat tissue in guanidine, the amyloid A protein concentration was measured by a monoclonal antibody-based sandwich ELISA.
RESULTS—The concentrations in 24 patients with arthritis and AA amyloidosis (median 236, range 1.1-8530 ng/mg tissue) were higher (...

  7. Independent Navigation System for a Surgical Colonoscope

    Directory of Open Access Journals (Sweden)

    Lilia A. Ochoa-Luna

    2013-08-01

    Full Text Available This paper provides a novel algorithm to attain the independent navigation of a colonoscopy surgical endoscope. First, it introduces a brief description of this issue through the scientist advance for medical robotics. It then makes a quickly count of the existent methods and at the end it provides the basis in order to propose a new alternative solution with help from vision-guidance. That means that images will be processed and interpreted with the purpose of maintaining the endoscope always at the intestine center. All this considered will help us to reduce colonoscopy surgeries consequences and the most important advantage of this new method proposed is that surgeons will accomplish their work easier and more efficiently.

  8. Aspirations of Life

    Institute of Scientific and Technical Information of China (English)

    Zhou; Ningxin

    2012-01-01

    After entering Senior Three, besides strenuous revisions and examinations, what the students think most and discuss most is aspirations of life. As far as I know, most of my classmates have already specified their choices of majors and their aspirations of life. Some classmates excel in science subjects, so they have chosen science and engineering subjects, hoping that they will become scientists or engineers.

  9. ASPIRE: Added-value Sensing

    DEFF Research Database (Denmark)

    Anggorojati, Bayu; Cetin, Kamil; Mihovska, Albena D.

    2010-01-01

    FP7 ICT project ASPIRE is one of the coordinated European efforts to further the advancement of this technology, in the areas of enabling technology development for RFID. The focus of ASPIRE is on the design, development and adoption of an innovative, programmable, royalty-free, lightweight...... and privacy friendly RFID middleware. Advances in active RFID integration with WSNs allow for more RFID-based applications to be developed. In order to fill the gap between the active RFID system and the existing middleware, a HAL for active reader and ALE server extension to support sensing data from active...

  10. Aspiration of Nasopore nasal packing.

    Science.gov (United States)

    Smith, Jonathan; Reddy, Ekambar

    2017-10-04

    We present a case of postoperative Nasopore aspiration in an otherwise fit and well 11-year-old. An endoscopic adenoidectomy had been performed without incident and Nasopore packing placed into each nasal cavity. Immediately after extubation, there was marked hypoxia, tachypnoea and high clinical suspicion of pack aspiration. The patient returned to theatre for emergency rigid bronchoscopy and retrieval of nasal packing. © BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  11. Evolution of a sustainable surgical delivery model.

    Science.gov (United States)

    Magee, William P

    2010-09-01

    For the past 28 years, Operation Smile has mobilized thousands of volunteers to provide life-changing cleft lip, cleft palate, and other facial deformity surgery to more than 150,000 children in countries all over the world. Our mission is to provide surgical care for children with the goal of developing sustainable health care delivery models for surgical services worldwide. For more than a quarter century, we have learned that good judgment comes from experience and that experience comes from bad judgment. However, it has been woven throughout this sometimes painful, always exhilarating growth process in which we have realized that our mission had so much more power than we initially anticipated that it would. Originally, we focused on the face of a child and our ability to provide a surgery that would change that child's life forever. Today, we still stand in awe of the transformative power of this experience, but we have also realized the great power that lies in educating medical professionals and providing state-of-the-art equipment. For us, action took shape in the form of us establishing a business model at home and in each of our partner countries. This included setting up financial reporting systems and creating program models that organized volunteers to provide care for children outside the reach of where surgery was currently available. Through our journey, we have realized that there is power in the healed face of a child. That moment gives us the opportunity to feel the passion for the service we have the privilege to provide. It is that emotion that leads us to action.

  12. Thyroid fine-needle aspiration with atypia of undetermined significance: a necessary or optional category?

    Science.gov (United States)

    Shi, Yan; Ding, Xin; Klein, Melissa; Sugrue, Chiara; Matano, Sandra; Edelman, Morris; Wasserman, Patricia

    2009-10-25

    Atypia of undetermined significance is a controversial category in thyroid fine-needle aspiration (FNA), not only for its questioned clinical utility, but also for its very existence as an expression of uncertainty. The current study was performed to investigate the potential impact of eliminating this category on the sensitivity and specificity for detecting thyroid neoplasms by FNA. Forty cases originally diagnosed as atypia of undetermined significance with histologic follow-up were selected for the present study. These cases were reinterpreted blindly by 2 experienced reviewers, who eliminated atypia of undetermined significance as a diagnostic possibility and reclassified these cases as either benign, follicular neoplasm, suspicious for malignancy, or malignant. Twenty-six cases of atypia of undetermined significance were randomly selected and reevaluated 6 months later to study intraobserver variation. After eliminating the atypia of undetermined significance category, the sensitivity for detecting papillary thyroid carcinoma (PTC) was reduced from 100% to 27% (P = .04). In those atypia of undetermined significance cases that were reclassified as benign, 37% had PTC. In those reclassified as follicular neoplasm or suspicious for malignancy, 38% were histologically proven to be benign lesions. Unanimous interobserver and intraobserver agreement was observed in only 60% of cases. Eliminating the diagnosis of atypia of undetermined significance substantially decreases the sensitivity of thyroid FNAs and increases both false-positive and false-negative rates. In addition, it increases interobserver and intraobserver variability. Therefore, the atypia of undetermined significance category should not be eliminated; but we advocate minimizing its use. (c) 2009 American Cancer Society.

  13. Surgical virtual reality - highlights in developing a high performance surgical haptic device.

    Science.gov (United States)

    Custură-Crăciun, D; Cochior, D; Constantinoiu, S; Neagu, C

    2013-01-01

    Just like simulators are a standard in aviation and aerospace sciences, we expect for surgical simulators to soon become a standard in medical applications. These will correctly instruct future doctors in surgical techniques without there being a need for hands on patient instruction. Using virtual reality by digitally transposing surgical procedures changes surgery in are volutionary manner by offering possibilities for implementing new, much more efficient, learning methods, by allowing the practice of new surgical techniques and by improving surgeon abilities and skills. Perfecting haptic devices has opened the door to a series of opportunities in the fields of research,industry, nuclear science and medicine. Concepts purely theoretical at first, such as telerobotics, telepresence or telerepresentation,have become a practical reality as calculus techniques, telecommunications and haptic devices evolved,virtual reality taking a new leap. In the field of surgery barrier sand controversies still remain, regarding implementation and generalization of surgical virtual simulators. These obstacles remain connected to the high costs of this yet fully sufficiently developed technology, especially in the domain of haptic devices.

  14. Implementing lean in a surgical ward

    DEFF Research Database (Denmark)

    Edwards, Kasper; Nielsen, Anders Paarup; Jacobsen, Peter

    Using the well-known principles from lean management in an orthopedic surgical ward at a major Danish hospital reorganized their work-flow and processes. The ward has ten operating rooms and performs the complete range of the orthopedic procedures ranging from patients that need simple standard...... for productivity improvement. Lean management has its origins in industrial production, but it is now being transferred to many other sectors, e.g., health care. Two important prerequisites exist for implementing lean management: Firstly, stable and standardized processes and secondly leveling of production...... be planned in advance and meet the prerequisites for lean management. Two of ten operating rooms have been allocated to this flow. Selected surgeons, nurses and porters have been allocated to the two operating rooms and they remain in the sterile environment for the duration of the workday. The effect...

  15. Implementing lean in a surgical ward

    DEFF Research Database (Denmark)

    Edwards, Kasper; Nielsen, Anders Paarup; Jacobsen, Peter

    of the lean implementation has been a 33% increase in patient throughput. The second flow is unchanged and concerned with non-standard and emergency procedures, e.g.., major hip surgery on old people or surgery on traffic victims. The surgeries within this flow are non-routine, unpredictable and cannot....... Stable and standardized processes ensure quality and predictability (e.g. process time). Leveling of production is essential for production planning. Based on the results of the case study of the surgical ward this paper will discuss three issues or challenges that emerged from the implementation of lean...... procedures to patients in need of complex emergency procedures. The primary result of the lean project has been to split the flow of patients in two. The first flow is concerned with highly standardized and non-emergency procedures, e.g. minor knee surgery. These surgeries are routine, predictable and can...

  16. Plying the steel: A reconsideration of surgical metaphors in psychoanalysis.

    Science.gov (United States)

    Ivey, Gavin

    2010-02-01

    Among the metaphors that Freud used to describe psychoanalysis, the surgical is possibly the most deplored. It is considered an anachronistic remnant of a dubious medical ideology that psychoanalysis has largely renounced. However, while analysts today avoid surgical analogies, their patients continue to produce surgical fantasies about analytic treatment. This fact alone requires a serious consideration of the meanings that surgical metaphors have for them. A second reason for reconsidering the role of the surgical metaphor, from the analyst's perspective, lies in its creative revival by W. R. Bion. Disregarding the shift away from surgical analogizing, Bion employed the metaphor to vividly portray various aspects of the analytic situation and the patient's experience of them. A brief historical overview of the surgical metaphor in psychoanalysis is provided, followed by an account of the reasons for its demise and by a review of the criticisms that continue to be leveled at it. Bion's use of surgical metaphors toward the end of his life is then explored. Finally, illustrations are given of the various ways in which patients use spontaneous surgical metaphors to depict transference and the analytic process. Though the analyst should not deliberately adopt surgical metaphors, it is important to remain open to these transference portrayals.

  17. Spontaneous rupture of an infected renal cyst and external drainage through a lumbar surgical scar in a male patient with cervical spinal cord injury: a case report

    Directory of Open Access Journals (Sweden)

    Vaidyanathan Subramanian

    2008-05-01

    Full Text Available Abstract Introduction The spontaneous rupture of an infected renal cyst is a rare event. Spontaneous rupture with drainage to the exterior through a surgical scar has not been reported previously. Case presentation A 49-year-old male with tetraplegia had undergone extended right pyelolithotomy in 1999. Deroofing and marsupialisation of a cyst in the upper pole of the right kidney was performed in 2003. Subsequently there was recurrence of a thick-walled cystic space-occupying lesion in the upper pole of the right kidney. Thick pus was aspirated from the renal cyst on six occasions between September 2003 and November 2004. In March 2006, ultrasound examination revealed a cyst measuring 6.2 cm in diameter in the upper pole of the right kidney. Aspiration was planned when the renal cyst reached 7.5 cm in diameter. However, 11 months later, the cyst ruptured spontaneously and drained through the previous surgical scar in the flank, while the patient was recovering from a severe chest infection in the spinal unit. Ultrasound examination showed a fistulous tract running between the renal cyst and the abdominal wall. Repeated minor trauma sustained during turning, hoisting and chest physiotherapy all may have contributed to the rupture of the infected renal cyst and drainage through a weak spot in the abdominal wall. Conclusion In hindsight, we might have prevented rupture of the renal cyst had we considered aspiration of the renal cyst before it reached 7.5 cm in diameter, although this 7.5 cm diameter, as the threshold for percutaneous aspiration, is an arbitrary setting. This patient could have been advised to wear an abdominal corset to protect the right flank from pressure applied unintentionally during turning, hoisting or assisted coughing.

  18. Fine needle aspiration cytology of rectal masses.

    Science.gov (United States)

    Kochhar, R; Rajwanshi, A; Wig, J D; Gupta, N M; Kesiezie, V; Bhasin, D K; Malik, A K; Gupta, S K; Mehta, S K

    1990-01-01

    This paper describes the results of transproctoscopic fine needle aspiration cytology in the diagnosis of rectal lesions. Fifty one consecutive patients referred with a presumptive diagnosis of rectal mass were subjected to proctoscopic examination when fine needle aspiration cytology, brush cytology and biopsy samples were taken. Of the 30 patients of malignancy of rectum in whom all the three sampling techniques were applied, the biopsy was positive in 27 (90%), brush cytology in 25 (83.3%) and fine needle aspiration cytology in 29 (96.6%). A combination of fine needle aspiration cytology with brush cytology gave a positive yield in 96.6% while that fine needle aspiration cytology with brush cytology gave a yield of 100%. Fine needle aspiration cytology was most helpful in infiltrative tumours. All 10 patients with secondaries in the pouch of Douglas or rectovesical pouch, and the single patient with submucosal rectal carcinoma were correctly diagnosed at fine needle aspiration cytology. There were no false positive results with fine needle aspiration cytology and no complications were encountered with the procedure. Images Figure 1 Figure 2 Figure 3 PMID:2323600

  19. Endometrial aspiration cytology in gynecological disorders

    Directory of Open Access Journals (Sweden)

    Meenal V Jadhav

    2016-01-01

    Full Text Available Context: Endometrial aspiration is not a popular modality for the study of the endometrium despite its simplicity and potential utility. Aim: The present study was aimed at evaluating the utility of endometrial aspiration in various gynecological disorders. Materials and Methods: In this diagnostic accuracy study, 55 prospectively registered women with various gynecological disorders were evaluated clinically and subjected to endometrial aspiration cytology and study of endometrial histology. Endometrial aspiration was performed by infant feeding tube in 10 cases and intra cath cannula in 45 cases. The slides were stained with rapid Papanicolaou (PAP stain and Leishman stain. Results: Endometrial aspiration cytology showed 90% and 94.6% sampling adequacy with infant feeding tube and intra cath cannula, respectively. Intra cath cannula was very convenient to handle and superior to infant feeding tube in aspirating the endometrium. Of the two stains used, rapid PAP stain was less time-consuming and superior to Leishman stain in studying the nuclear details. Leishman stain was helpful in detecting cytoplasmic vacuoles of secretory endometrium. Overall diagnostic accuracy of endometrial cytology was 90.4% while that for morphological hormonal evaluation was 97.6%. It enjoyed a sensitivity of 91.66%, a specificity of 88.23%, positive predictive value of 94.28%, and negative predictive value of 83.33%. Conclusion: Intra cath cannula emerged as an inexpensive, effective, and convenient device for endometrial aspiration. Endometrial aspiration proved to be a fairly effective, simple, and informative diagnostic modality.

  20. Chronic inflammation, lymphangiogenesis, and effect of an anti-VEGFR therapy in a mouse model and in human patients with aspiration pneumonia.

    Science.gov (United States)

    Nihei, Mayumi; Okazaki, Tatsuma; Ebihara, Satoru; Kobayashi, Makoto; Niu, Kaijun; Gui, Peijun; Tamai, Tokiwa; Nukiwa, Toshihiro; Yamaya, Mutsuo; Kikuchi, Toshiaki; Nagatomi, Ryoichi; Ebihara, Takae; Ichinose, Masakazu

    2015-03-01

    Chronic inflammation induces lymphangiogenesis and blood vessel remodelling. Since aged pneumonia patients often have repeated episodes of aspiration pneumonia, the pathogenesis may involve chronic inflammation. For lymphangiogenesis, VEGFR-3 and its ligand VEGF-C are key factors. No previous studies have examined chronic inflammation or vascular changes in aspiration pneumonia or its mouse models. In lung inflammation, little is known about the effect of blocking VEGFR-3 on lung lymphangiogenesis and, moreover, its effect on the disease condition. This study aimed to establish a mouse model of aspiration pneumonia, examine the presence of chronic inflammation and vascular changes in the model and in patients, and evaluate the effect of inhibiting VEGFR-3 on the lymphangiogenesis and disease condition in this model. To induce aspiration pneumonia, we repeated inoculation of pepsin at low pH and LPS into mice for 21-28 days, durations in which bronchioalveolar lavage and plasma leakage in the lung suggested the presence of exaggerated inflammation. Conventional and immunohistochemical analysis of tracheal whole mounts suggested the presence of chronic inflammation, lymphangiogenesis, and blood vessel remodelling in the model. Quantitative RT-PCR of the trachea and lung suggested the involvement of lymphangiogenic factor VEGF-C, VEGFR-3, and pro-inflammatory cytokines. In the lung, the aspiration model showed the presence of chronic inflammation and exaggerated lymphangiogenesis. Treatment with the VEGFR inhibitor axitinib or the VEGFR-3 specific inhibitor SAR131675 impaired lymphangiogenesis in the lung and improved oxygen saturation in the aspiration model. Since the lung is the main site of aspiration pneumonia, the changes were intensive in the lung and mild in the trachea. Human lung samples also showed the presence of chronic inflammation and exaggerated lymphangiogenesis, suggesting the relevance of the model to the disease. These results suggest lymphatics in

  1. FINE NEEDLE ASPIRATION CYTOLOGY OF RETROPERITONEAL GANGLIONEUROBLASTOMA – A CASE REPORT

    Directory of Open Access Journals (Sweden)

    Rajshekhar

    2013-01-01

    Full Text Available ABSTRACT: Ganglioneuroblastoma is an uncommon peripheral neurob lastic tumor. They have intermediate malignant potential, in between that of neuroblastomas and ganglioneuromas. Histologically, they are considered to have interme diate malignant potential because they contain primitive neuroblasts along with mature gang lion cells. In literature, reports of this entity being diagnosed by fine needle aspiration and its cytological appearance are scarce. KEY WORDS: Ganglioneuroblastoma, FNA, Neuroblastoma

  2. A Case of Gastrointestinal Stromal Tumor That Underwent Endoscopic Ultrasound-Guided Aspiration with a 25-Gauge Biopsy Needle

    Directory of Open Access Journals (Sweden)

    Minoru Tomizawa

    2016-05-01

    Full Text Available Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA is performed to obtain specimens for pathological analysis. For this procedure, 19-gauge (19G, 22-guage (22G, and 25-guage (25G needles are available. The needles are classified into aspiration type and biopsy type. A 56-year-old woman underwent upper gastrointestinal endoscopy that showed a 38-mm-diameter submucosal tumor. The elevated lesion was diagnosed as a submucosal tumor of the stomach. Contrast-enhanced computed tomography showed a low-density area on the luminal surface of the gastric wall, which was covered with a thin layer of gastric mucosa. EUS showed a hypoechoic lesion in the submucosal layer. Color Doppler image showed a pulsating vascular signal extending into the center of the hypoechoic lesion from the periphery. EUS-FNA was performed with a 25G biopsy needle. The specimen tissue consisted of spindle-shaped cells. The cells were positive for CD117 and CD34. The submucosal tumor was diagnosed as a gastrointestinal stromal tumor.

  3. A Case of Gastrointestinal Stromal Tumor That Underwent Endoscopic Ultrasound-Guided Aspiration with a 25-Gauge Biopsy Needle.

    Science.gov (United States)

    Tomizawa, Minoru; Shinozaki, Fuminobu; Motoyoshi, Yasufumi; Sugiyama, Takao; Yamamoto, Shigenori; Ishige, Naoki

    2016-01-01

    Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is performed to obtain specimens for pathological analysis. For this procedure, 19-gauge (19G), 22-guage (22G), and 25-guage (25G) needles are available. The needles are classified into aspiration type and biopsy type. A 56-year-old woman underwent upper gastrointestinal endoscopy that showed a 38-mm-diameter submucosal tumor. The elevated lesion was diagnosed as a submucosal tumor of the stomach. Contrast-enhanced computed tomography showed a low-density area on the luminal surface of the gastric wall, which was covered with a thin layer of gastric mucosa. EUS showed a hypoechoic lesion in the submucosal layer. Color Doppler image showed a pulsating vascular signal extending into the center of the hypoechoic lesion from the periphery. EUS-FNA was performed with a 25G biopsy needle. The specimen tissue consisted of spindle-shaped cells. The cells were positive for CD117 and CD34. The submucosal tumor was diagnosed as a gastrointestinal stromal tumor.

  4. Pre-aspiration in Welsh English: a case study of Aberystwyth

    DEFF Research Database (Denmark)

    Hejná, Michaela

    of as the most important. Chapter 7 finds that women pre-aspirate more frequently than men, which is in accordance with many pre-aspiration studies, but this difference decreases as the age decreases and results in no gender difference in the youngest speakers. Breathiness is not affected by gender......, if it is sensitive to social factors such as age or gender as well, and it suggests some implications for sound changes including pre-aspiration. Chapter 1 summarises the questions addressed in this thesis and outlines where this work is positioned with respect to our current knowledge of the phenomenon...... at least equally well as breathiness, voicing, release duration, or the duration of the preceding vowel, and better than voiceless closure duration, glottalisation, or f0 before or after the plosive in question in the word- medial (cotter [khɒhtsə] ~ codder [khɒdə]) and the word-final positions (cot...

  5. Adolescents Aspiration and Their Parental Relations: A Study among Rural School Going Adolescents in a Block of Darjeeling District

    Directory of Open Access Journals (Sweden)

    I. Dey

    2011-10-01

    Full Text Available Background: Adolescents’ future aspirations and expectations are important precursor of adult attainment. Objectives: To document rural adolescents’ understanding of their aspirations and the problems they face for achieving them. The relationship of adolescents with their family and how they feel about themselves have also been determined. Methods: This was a cross-sectional study conducted among school-going adolescents of Fashidewa block of Darjeeling district from July to October, 2007. A total of 420 students comprised the study population. Results - Among them, 41.4%, responded that they want to pursue a professional career in future. Poverty was found to be the commonest obstacle. The commonest problem-solving method was having discussions with friends. The study revealed that 56.4% of the adolescents communicated their problem and about 27.6% of them had conflict with their parents in last one year. Conclusion: Interventions at the community level like youth clubs for safe social interaction and literacy classes, training of peer educators to teach life-skills, forums for parents and teachers to discuss their own concerns and those of the adolescents may help to design programmes that will contribute to greater financial independence and employment opportunities for adolescents

  6. Workload, Aspiration, and Fun

    DEFF Research Database (Denmark)

    Muhr, Sara Louise; Pedersen, Michael; Alvesson, Mats

    2012-01-01

    Contemporary working life highlights the challenge between exploitation and exploration both on a general and a more individual level. Here, we focus on the latter, and connect the critical debate regarding selfmanagement to March’s exploitation/exploration trade-off, as this forms a useful...... study of a large group of management consultants, we explore how they perform and make sense of selfexploitation and self-exploration through three specific discourses: the discourse of workload, the discourse of aspiration, and the discourse of fun. Through these, the consultants try to identify...... optimal amounts of work, play, and ambition, all while handling the trade-off between selfexploitation and self-exploration. We show how this keeps failing, but how it reappears as a necessary condition for avoiding future failures. In all three discourses, the trade-off therefore presents itself...

  7. Fine needle aspiration biopsy to reestablish cell culture in an animal model of uveal melanoma.

    Science.gov (United States)

    Correa, Zelia Maria da Silva; Marshall, Jean-Claude; Souza Filho, João Pessoa; Odashiro, Alexandre Nakao; Burnier Jr, Miguel Noel

    2009-01-01

    To access the reliability of fine-needle aspiration biopsy in harvesting a sufficient amount of viable melanoma cells to establish a cell culture and maintain a melanoma cell line from an animal model of uveal melanoma. For this study, fifteen male New Zealand albino rabbits had their right eye surgically inoculated with uveal melanoma cell line 92.1. The animals were immunosupressed with cyclosporine A using a dose schedule previously published. The animals were followed for 12 weeks. Intraocular tumor growth was monitored weekly by indirect ophthalmoscopy. After the fourth week, one animal was sacrificed per week preceded by fine-needle aspiration biopsy using a sharp 25-gauge, 1-inch long needle. Two separate aspirates were made from different areas of the tumor. Each aspirate was flushed to a separate cell culture media and sent for cell culture. The cells were frozen after two weeks when there were at least 1 million cells, which is enough to maintain a cell line. Cells were defrosted for HMB-45 immuno-stains to confirm the melanoma origin. Cell growth was observed from the samples harvested from 11 out of the 15 animals inoculated with uveal melanoma. All cell cultures, after defrost, immunoassayed positive for HMB-45. Fine needle aspiration biopsy seems to be a reliable method to harvest cells from solid intraocular melanomas in an animal model, to establish cell culture and to maintain a melanoma cell line.

  8. A prototype surgical manipulator for robotic intraocular micro surgery.

    Science.gov (United States)

    Mulgaonkar, Amit P; Hubschman, Jean-Pierre; Bourges, Jean-Louis; Jordan, Brett L; Cham, Christopher; Wilson, Jason T; Tsao, Tsu-Chin; Culjat, Martin O

    2009-01-01

    A prototype manipulator system was developed for ophthalmologic microsurgery. The system, consisting of two parallel X-Y stages, can mechanically maintain a fixed-point of rotation at the surface of the eye, potentially reducing trauma during surgical procedures. The initial prototype was designed to function in concert with the da Vinci Surgical System for gross positioning. Robotic tests demonstrated the mechanical fitness of the prototype while an in vitro surgical sclerectomy was performed to demonstrate functionality of the approach.

  9. Surgical considerations for ′intrinsic′ brainstem gliomas: Proposal of a modification in classification

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    Mehta V

    2009-01-01

    Full Text Available Background: Brainstem gliomas are highly heterogeneous tumors both in their clinical manifestation and in their pathology. Despite significant advances in the surgery for brainstem gliomas many aspects of this pathology are still unclear Objective: To evaluate the clinical, radiological and surgical outcome of 40 focal ′intrinsic′ brainstem gliomas and propose a surgical strategy-oriented classification. Materials and Methods: A total of 40 focal ′intrinsic′ ("expanding variety" tumors have been operated over a period of 8.5-years (January 1998-June 2007. Our criteria included patients with (1 well-defined gadolinium enhancing tumor; (2 relatively long duration of symptoms (> six months and (3 good neurological functional status and independent for all activities of daily living. The cutoff size of 2 cm was not rigidly adhered to. Results: The ′intrinsic′ brainstem tumors were classified into three types: Expanding, diffuse infiltrative and pure ventral varieties. Only patients with expanding variety of brainstem gliomas were subjected to surgery, mean age 19.2 years (range 4-55 years and male to female ration mean: 3:2. The tumor location included pons (n=19, midbrain (n=13 and medulla (n=8. Surgical approaches included midline suboccipital (n=28, retromastoid (n=7, subtemporal (n=3 and supracerebellar-infratentorial (n=2. Thirty-two cases with ′diffuse infiltrative′ and ′pure ventral′ variety were given radiotherapy only. Histology pathology revealed pilocytic variety (n=10, Grade II (n=17 and Grade III (n=13. There was one death in the surgical series (due to aspiration. Complications included meningitis (n=2, wound infection (n=1, chest infection (n=5 and transient mutism (n=1. Follow-up ranged from 3-68 months. Overall, 36 improved /remained same and three worsened in their clinical status at the time of discharge. Conclusion: The surgical management of intrinsic brainstem tumors presents a surgical challenge; radical

  10. Excised Abdominoplasty Material as a Systematic Plastic Surgical Training Model

    Directory of Open Access Journals (Sweden)

    M. Erol Demirseren

    2012-01-01

    Full Text Available Achieving a level of technical skill and confidence in surgical operations is the main goal of plastic surgical training. Operating rooms were accepted as the practical teaching venues of the traditional apprenticeship model. However, increased patient population, time, and ethical and legal considerations made preoperation room practical work a must for plastic surgical training. There are several plastic surgical teaching models and simulators which are very useful in preoperation room practical training and the evaluation of plastic surgery residents. The full thickness skin with its vascular network excised in abdominoplasty procedures is an easily obtainable real human tissue which could be used as a training model in plastic surgery.

  11. Historical review of surgical simulation--a personal perspective.

    Science.gov (United States)

    Satava, Richard M

    2008-02-01

    Although simulation is relatively new to surgical education, there is a long history in many other disciplines, such as military, aviation, and nuclear power plant operations, among others. In the late 1980s these technologies began to be adapted to the surgical world, along with the new technology of virtual reality. This is a review of the introduction of manikins, computers, and virtual reality into education and training for surgical skills. Two concomitant revolutions occurred: objective assessment of surgical skills and converting training from the apprenticeship model to one of criterion-based training. A personal perspective on these developments adds information not previously published.

  12. Necrotizing fasciitis: A decade of surgical intensive care experience

    OpenAIRE

    Shaikh Nissar

    2006-01-01

    Necrotizing fasciitis is a rare disease, potentially limb and life-threatening infection of fascia, subcutaneous tissue with occasionally muscular involvement. Necrotizing faciitis is surgical emergency with high morbidity and mortality. Aim: Aim of this study was to analyze presentation, microbiology, surgical, resuscitative management and outcome of this devastating soft tissue infection. Materials and Methods: The medical records of necrotizing fasciitis patients treated in surgical in...

  13. Development of a Cognitive Robotic System for Simple Surgical Tasks

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    Riccardo Muradore

    2015-04-01

    Full Text Available The introduction of robotic surgery within the operating rooms has significantly improved the quality of many surgical procedures. Recently, the research on medical robotic systems focused on increasing the level of autonomy in order to give them the possibility to carry out simple surgical actions autonomously. This paper reports on the development of technologies for introducing automation within the surgical workflow. The results have been obtained during the ongoing FP7 European funded project Intelligent Surgical Robotics (I-SUR. The main goal of the project is to demonstrate that autonomous robotic surgical systems can carry out simple surgical tasks effectively and without major intervention by surgeons. To fulfil this goal, we have developed innovative solutions (both in terms of technologies and algorithms for the following aspects: fabrication of soft organ models starting from CT images, surgical planning and execution of movement of robot arms in contact with a deformable environment, designing a surgical interface minimizing the cognitive load of the surgeon supervising the actions, intra-operative sensing and reasoning to detect normal transitions and unexpected events. All these technologies have been integrated using a component-based software architecture to control a novel robot designed to perform the surgical actions under study. In this work we provide an overview of our system and report on preliminary results of the automatic execution of needle insertion for the cryoablation of kidney tumours.

  14. Development of a Cognitive Robotic System for Simple Surgical Tasks

    Directory of Open Access Journals (Sweden)

    Riccardo Muradore

    2015-04-01

    Full Text Available The introduction of robotic surgery within the operating rooms has significantly improved the quality of many surgical procedures. Recently, the research on medical robotic systems focused on increasing the level of autonomy in order to give them the possibility to carry out simple surgical actions autonomously. This paper reports on the development of technologies for introducing automation within the surgical workflow. The results have been obtained during the ongoing FP7 European funded project Intelligent Surgical Robotics (I-SUR. The main goal of the project is to demonstrate that autonomous robotic surgical systems can carry out simple surgical tasks effectively and without major intervention by surgeons. To fulfil this goal, we have developed innovative solutions (both in terms of technologies and algorithms for the following aspects: fabrication of soft organ models starting from CT images, surgical planning and execution of movement of robot arms in contact with a deformable environment, designing a surgical interface minimizing the cognitive load of the surgeon supervising the actions, intra-operative sensing and reasoning to detect normal transitions and unexpected events. All these technologies have been integrated using a component-based software architecture to control a novel robot designed to perform the surgical actions under study. In this work we provide an overview of our system and report on preliminary results of the automatic execution of needle insertion for the cryoablation of kidney tumours.

  15. “Everybody Gotta Have a Dream”: Rap-centered Aspirations among Young Black Males Involved in Rap Music Production – A Qualitative Study

    Science.gov (United States)

    Foster, B. Brian

    2015-01-01

    Youth express diverse desires for their educational and occupational futures. Sometimes these aspirations are directed towards somewhat unconventional careers such as rapping and other types of involvement in rap music production. Although many studies have examined traditional educational and occupational aspirations, less is known about the factors that give rise to rap-centered aspirations and how individuals pursue them, particularly as they transition to early adulthood. Drawing on 54 semi- and unstructured interviews with 29 black young men involved in rap music production, I find that rap-centered aspirations are shaped by a range of factors, most notably feedback regarding one’s rap skills, access to recording and production equipment, and the financial means to maintain involvement in rap music production while also ensuring personal and family economic stability. The young men in the study attached different meanings to their aspirations and sometimes recast their motivations for participating in rap music production in response to various social and economic factors. PMID:26005703

  16. Risk of aspiration in care home residents and associated factors

    NARCIS (Netherlands)

    Maarel-Wierink, C.D. van der; Putten, G.J. van der; Visschere, L.M. De; Bronkhorst, E.M.; Baat, C. de; Schols, J.M.

    2015-01-01

    Pneumonia is a prevalent cause of death in care home residents. Dysphagia is a significant risk factor of aspiration pneumonia. The purpose of the current study was to screen for risk of aspiration in care home residents in the Netherlands and assess potential risk factors of aspiration. Five experi

  17. Can a one-day practical lesson in surgical skills encourage medical students to consider a surgical career?

    Science.gov (United States)

    Bauer, Florian; Rommel, Niklas; Koerdt, Steffen; Fichter, Andreas; Wolff, Klaus-Dietrich; Kesting, Marco R

    2016-05-01

    Interest in a surgical career is declining among medical students, and many more need to commit themselves to becoming surgeons to cope with this. We have therefore developed a one-day practical lesson in surgical skills to find out whether a short course such as this can make students more enthusiastic about surgery, and about subsequently pursuing a career in one of its subspecialties. Fifty-four randomly-selected medical students did a one-day practical course in the skills required for maxillofacial surgical specialties. The 4 subdivisions involved - traumatology, resection of a tumour (cancer surgery), plastic surgery (microsurgery), and cleft lip and palate surgery. All students took written tests and completed an evaluation form about their interest in a surgical career before and after training. There was a significant increase in test scores in almost all categories at the end of the course, and significantly more students were prepared to consider a surgical career or a career in maxillofacial surgery after the training. This study shows that a one-day training course in surgical skills can significantly improve medical students' surgical knowledge, and might encourage them to enter a surgical career. We recommend the integration of a short training course such as this into the medical school curriculum. Only time and further evaluation will tell whether this increased exposure to surgical techniques can be transformed into additional surgeons.

  18. Investigation of scanning parameters for thyroid fine needle aspiration cytology specimens: A pilot study

    Directory of Open Access Journals (Sweden)

    Maheswari S Mukherjee

    2015-01-01

    Full Text Available Background: Interest in developing more feasible and affordable applications of virtual microscopy in the field of cytology continues to grow. Aims: The aim of this study was to investigate the scanning parameters for the thyroid fine needle aspiration (FNA cytology specimens. Subjects and Methods: A total of twelve glass slides from thyroid FNA cytology specimens were digitized at ×40 with 1 micron (μ interval using seven focal plane (FP levels (Group 1, five FP levels (Group 2, and three FP levels (Group 3 using iScan Coreo Au scanner (Ventana, AZ, USA producing 36 virtual images (VI. With an average wash out period of 2 days, three participants diagnosed the preannotated cells of Groups 1, 2, and 3 using BioImagene′s Image Viewer (version 3.1 (Ventana, Inc., Tucson, AZ, USA, and the corresponding 12 glass slides (Group 4 using conventional light microscopy. Results: All three raters correctly identified and showed complete agreement on the glass and VI for: 86% of the cases at FP Level 3, 83% of the cases at both the FP Levels 5 and 7. The intra-observer concordance between the glass slides and VI for all three raters was highest (97% for Level 3 and glass, same (94% for Level 5 and glass; and Level 7 and glass. The inter-rater reliability was found to be highest for the glass slides, and three FP levels (77%, followed by five FP levels (69.5%, and seven FP levels (69.1%. Conclusions: This pilot study found that among the three different FP levels, the VI digitized using three FP levels had slightly higher concordance, intra-observer concordance, and inter-rater reliability. Scanning additional levels above three FP levels did not improve concordance. We believe that there is no added benefit of acquiring five FP levels or more especially when considering the file size, and storage costs. Hence, this study reports that FP level three and 1 μ could be the potential scanning parameters for the thyroid FNA cytology specimens.

  19. Surgical treatment of a Malgaigne fracture.

    Science.gov (United States)

    Dalbayrak, Sedat; Ayten, Murat; Özer, Fahir; Yaman, Onur

    2014-07-01

    Sacral fractures are generally accompanied by pelvic ring fractures. They rarely develop in an isolated form. Sacroiliac dislocation without sacral fracture is extremely rare. We report a case with a sacroiliac dislocation without sacral fracture, which was treated surgically. Lumbopelvic stabilization was applied using iliac wing plates. The case was evaluated according to his clinical condition and visual analogue score (VAS), American Spinal Injury Association (ASIA) and Oswestry scales. Considering the role of the sacrum, which transmits the load of the entire spine to the pelvis, meticulous care must be given to ensure the mechanic stability of the spine when evaluating patients with sacral and pelvic fractures. Very serious spinopelvic instability is present in sacroiliac dislocations even in the absence of sacral fractures. Caudal migration of the sacrum together with the cranial migration of the iliac wings can cause serious pelvic imbalance and difficulties in walking and maintaining a standing position. Aggressive stabilization and fusion are required, and these must be performed in the early period.

  20. Fine needle aspiration biopsy to reestablish cell culture in an animal model of uveal melanoma

    OpenAIRE

    Correa, Zelia Maria da Silva; Marshall,Jean-Claude; Souza Filho,João Pessoa de; Odashiro, Alexandre Nakao; Burnier, Jr.,Miguel Noel

    2009-01-01

    PURPOSE: To access the reliability of fine-needle aspiration biopsy in harvesting a sufficient amount of viable melanoma cells to establish a cell culture and maintain a melanoma cell line from an animal model of uveal melanoma. METHODS: For this study, fifteen male New Zealand albino rabbits had their right eye surgically inoculated with uveal melanoma cell line 92.1. The animals were immunosupressed with cyclosporine A using a dose schedule previously published. The animals were followed fo...

  1. Diagnosis of invasive aspergillus tracheobronchitis facilitated by endobronchial ultrasound-guided transbronchial needle aspiration: a case report

    Directory of Open Access Journals (Sweden)

    Casal Roberto F

    2009-11-01

    Full Text Available Abstract Introduction Invasive pulmonary aspergillosis is the most common form of infection by Aspergillus species among immunocompromised patients. Although this infection frequently involves the lung parenchyma, it is unusual to find it limited to the tracheobronchial tree, a condition known as invasive aspergillus tracheobronchitis. Case presentation A 65 year-old Hispanic man from Bolivia with a history of chronic lymphocytic leukemia developed cough and malaise eight months after having an allogenic stem cell transplant. A computed tomography of the chest revealed an area of diffuse soft tissue thickening around the left main stem bronchus, which was intensely fluorodeoxyglucose-avid on positron emission tomography scanning. An initial bronchoscopic exam revealed circumferential narrowing of the entire left main stem bronchus with necrotic and friable material on the medial wall. Neither aspirates from this necrotic area nor bronchial washing were diagnostic. A second bronchoscopy with endobronchial ultrasound evidenced a soft tissue thickening on the medial aspect of the left main stem bronchus underlying the area of necrosis visible endoluminally. Endobronchial ultrasound-guided transbronchial needle aspiration performed in this area revealed multiple fungal elements suggestive of Aspergillus species. Conclusion We describe the first case of invasive aspergillus tracheobronchitis in which the diagnosis was facilitated by the use of endobronchial ultrasound guided trans-bronchial needle aspiration. To the best of our knowledge, we are also presenting the first positron emission tomography scan images of this condition in the literature. We cautiously suggest that endobronchial ultrasound imaging may be a useful tool to evaluate the degree of invasion and the involvement of vascular structures in these patients prior to bronchoscopic manipulation of the affected areas in an effort to avoid potentially fatal hemorrhage.

  2. Three-dimensional virtual bronchoscopy using a tablet computer to guide real-time transbronchial needle aspiration.

    Science.gov (United States)

    Fiorelli, Alfonso; Raucci, Antonio; Cascone, Roberto; Reginelli, Alfonso; Di Natale, Davide; Santoriello, Carlo; Capuozzo, Antonio; Grassi, Roberto; Serra, Nicola; Polverino, Mario; Santini, Mario

    2017-04-01

    We proposed a new virtual bronchoscopy tool to improve the accuracy of traditional transbronchial needle aspiration for mediastinal staging. Chest-computed tomographic images (1 mm thickness) were reconstructed with Osirix software to produce a virtual bronchoscopic simulation. The target adenopathy was identified by measuring its distance from the carina on multiplanar reconstruction images. The static images were uploaded in iMovie Software, which produced a virtual bronchoscopic movie from the images; the movie was then transferred to a tablet computer to provide real-time guidance during a biopsy. To test the validity of our tool, we divided all consecutive patients undergoing transbronchial needle aspiration retrospectively in two groups based on whether the biopsy was guided by virtual bronchoscopy (virtual bronchoscopy group) or not (traditional group). The intergroup diagnostic yields were statistically compared. Our analysis included 53 patients in the traditional and 53 in the virtual bronchoscopy group. The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy for the traditional group were 66.6%, 100%, 100%, 10.53% and 67.92%, respectively, and for the virtual bronchoscopy group were 84.31%, 100%, 100%, 20% and 84.91%, respectively. The sensitivity ( P  = 0.011) and diagnostic accuracy ( P  = 0.011) of sampling the paratracheal station were better for the virtual bronchoscopy group than for the traditional group; no significant differences were found for the subcarinal lymph node. Our tool is simple, economic and available in all centres. It guided in real time the needle insertion, thereby improving the accuracy of traditional transbronchial needle aspiration, especially when target lesions are located in a difficult site like the paratracheal station.

  3. Sulindac and Sulindac Metabolites in Nipple Aspirate Fluid and Effect on Drug Targets in a Phase I Trial

    OpenAIRE

    Thompson, Patricia A.; Hsu, Chiu-Hsieh; Green, Sylvan; Stopeck, Alison T.; Johnson, Karen; Alberts, David S.; Chow, H.-H. Sherry

    2010-01-01

    Regular use of nonsteroidal anti-inflammatory drugs (NSAIDs) has been associated with reduced risk of breast cancer. Sulindac, a non-selective NSAID with both cyclooxygenase 2 (COX2) dependent and independent activities, is a candidate for breast chemoprevention. We conducted a Phase Ib trial in 30 women at increased risk for breast cancer to evaluate the breast tissue distribution of sulindac at two dose levels (150 mg q.d. and 150 mg b.i.d. for 6 weeks), using nipple aspirate fluid (NAF) as...

  4. Role of fine needle aspiration cytology and cell block in diagnosis of scar endometriosis: A case report

    Directory of Open Access Journals (Sweden)

    Sashibhusan Dash

    2015-01-01

    Full Text Available Presence of endometrial glands and stroma in places other than the uterus is called endometriosis. It can be pelvic or extra-pelvic. Abdominal scar endometriosis is an extra-pelvic endometriosis that can occur after surgery involving the uterus. Post-caesarean section, scar endometriosis is a rare event. The diagnosis is frequently made only after excision of disease tissue. We present a case of post-caesarean section abdominal scar endometriosis presenting as a tumor on the abdominal wall, which was diagnosed by fine needle aspiration cytology and confirmed by cell block preparation.

  5. Fine-needle aspiration cytology of ovarian steroid cell tumor: A rare case report

    Directory of Open Access Journals (Sweden)

    Nidhi Agrawal

    2015-01-01

    Full Text Available Steroid cell tumors (SCTs of the ovary are a rare subgroup of sex cord tumors that account for less than 0.1% of all ovarian tumors. These tumors can produce steroids, especially testosterone, which produces symptoms such as hirsutism, amenorrhea/oligomenorrhea, and male patterned voice. For evaluation of the androgen excess, testosterone and dehydroepiandrosterone sulfate (DHEA-S are the first laboratory tests to be measured. Abdominal ultrasound and magnetic resonance imaging (MRI are useful radiologic imaging techniques. Although SCTs are generally benign, the risk of malignant transformation is always present. Surgical excision of tumor is the most important and hallmark treatment. The present case signifies the early preoperative diagnosis of a virilizing SCT, based on cytological features and its careful correlation with clinicopathological and radiological findings.

  6. Utility of intranasal Ketamine and Midazolam to perform gastric aspirates in children: a double-blind, placebo controlled, randomized study

    Science.gov (United States)

    2014-01-01

    Background We performed a prospective, randomized, placebo-controlled study aimed to evaluate the efficacy and safety of a sedation protocol based on intranasal Ketamine and Midazolam (INKM) administered by a mucosal atomizer device in uncooperative children undergoing gastric aspirates for suspected tuberculosis. Primary outcome: evaluation of Modified Objective Pain Score (MOPS) reduction in children undergoing INKM compared to the placebo group. Secondary outcomes: evaluation of safety of INKM protocol, start time sedation effect, duration of sedation and evaluation of parents and doctors’ satisfaction about the procedure. Methods In the sedation group, 19 children, mean age 41.5 months, received intranasal Midazolam (0.5 mg/kg) and Ketamine (2 mg/kg). In the placebo group, 17 children received normal saline solution twice in each nostril. The child’s degree of sedation was scored using the MOPS. A questionnaire was designed to evaluate the parents’ and doctors’ opinions on the procedures of both groups. Results Fifty-seven gastric washings were performed in the sedation-group, while in the placebo-group we performed 51 gastric aspirates. The degree of sedation achieved by INMK enabled all procedures to be completed without additional drugs. The mean duration of sedation was 71.5 min. Mean MOPS was 3.5 (range 1-8) in the sedation-group, 7.2 (range 4-9) in the placebo-group (p <0.0001). The questionnaire revealed high levels of satisfaction by both doctors and parents in the sedation-group compared to the placebo-group. The only side effect registered was post-sedation agitation in 6 procedures in the sedation group (10.5%). Conclusions Our experience suggests that atomized INKM makes gastric aspirates more acceptable and easy to perform in children. Trial registration Unique trial Number: UMIN000010623; Receipt Number: R000012422. PMID:24598046

  7. Scalp Melanoma Diagnosed by Fine Needle Aspiration Cytology in a Tertiary Health Center

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    A. B. Zarami

    2015-01-01

    Full Text Available Melanoma is one of the most aggressive malignant skin neoplasms worldwide with more than 20% of world melanoma seen in black Africa and Asia. Late presentation due to ignorance, poverty, and lack of adequate health facility in Nigeria is always the norms. We present this case report because of precision in diagnosis, using fine needle aspiration cytology (FNAC to reemphasize that the technique is cheap, cost effective, and quick that can reduce the burden of incisional biopsy before definitive surgery and improve early detection of the disease especially in developing countries.

  8. Delayed onset, protracted delirium and aspiration pneumonitis associated with a combination of clozapine and electroconvulsive therapy

    Directory of Open Access Journals (Sweden)

    N Manjunatha

    2011-01-01

    Full Text Available Few studies reported the efficacy and safety in combination of clozapine and electroconvulsive therapy (ECT in schizophrenia; systematic studies are lacking. Side effects like seizure, and confusional state are reported. Authors report two cases of delayed onset/protracted delirium with ECT and clozapine in schizophrenia, one of whom developed aspiration pneumonitis possibly due to clozapine hyper-salivation. Delirium improved with stopping of ECT and clozapine. Clozapine monotherapy restarted to previous dosages in both cases without recurrence of delirium. Authors recommend for careful monitoring for delirium in ECT augmentation on high dose clozapine. Unilateral ECT may be preferred for augmenting clozapine.

  9. Fine-needle aspiration versus core needle biopsy for diagnosis of thyroid malignancy and neoplasm: a matched cohort study.

    Science.gov (United States)

    Kim, Soo-Yeon; Lee, Hye Sun; Moon, Jieun; Kim, Eun-Kyung; Moon, Hee Jung; Yoon, Jung Hyun; Kwak, Jin Young

    2017-02-01

    To compare the diagnostic performances of fine-needle aspiration (FNA) and core needle biopsy (CNB) in the diagnosis of thyroid malignancy and neoplasm in patients who underwent surgery for thyroid nodules. This retrospective study was approved by the institutional review board, and the need to obtain informed consent was waived. 3192 patients who underwent FNA (n = 3048) or CNB (n = 144) for diagnosis of thyroid nodules and then proceeded with surgery were included. Surgical pathologic diagnosis was the reference standard. Diagnostic performances of FNA and CNB to predict malignancy and neoplasm were compared. Propensity score matching was used to match patients with FNA with those with CNB because there were significant differences in the number of nodules and nodule characteristics between the FNA and CNB groups. Before matching, the sensitivity and accuracy of FNA were significantly higher or comparable with those of CNB, and the specificity, negative predictive value and positive predictive value were comparable. After matching, the diagnostic performances were similar, with the exception of specificity for predicting neoplasm being higher with CNB than with FNA. FNA showed comparable diagnostic performance to CNB; therefore, there may be no benefit in performing CNB to diagnose papillary thyroid carcinoma and neoplasm. • Diagnostic performances of FNA and CNB for thyroid malignancy and neoplasm were compared. • FNA showed comparable performances to CNB both before and after statistical matching. • There may be no benefit in performing CNB, given the comparable performances.

  10. Ultrasound-guided fine needle aspiration of thyroid nodules: A consensus statement by the Korean Society of Thyroid Radiology

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Young Hen; Baek, Jung Hwan [Dept. of Radiology, Ansan Hospital, Korea University College of Medicine, Ansan (Korea, Republic of); Jung, So Lyoung [Dept. of Radiology, Seoul St. Mary' s Hospital, College of Medicine, The Catholic University of Korea, Seoul (Korea, Republic of); Kwak, Jin Young [Dept. of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul (Korea, Republic of); Kim, Ji Hoon [Dept. of Radiology, Seoul National University College of Medicine, Seoul (Korea, Republic of); Shin, Jung Hee [Dept. of Radiology, and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of)

    2015-04-15

    Ultrasound (US)-guided fine needle aspiration (US-FNA) has played a crucial role in managing patients with thyroid nodules, owing to its safety and accuracy. However, even with US guidance, nondiagnostic sampling and infrequent complications still occur after FNA. Accordingly, the Task Force on US-FNA of the Korean Society of Thyroid Radiology has provided consensus recommendations for the US-FNA technique and related issues to improve diagnostic yield. These detailed procedures are based on a comprehensive analysis of the current literature and from the consensus of experts.

  11. Endoscopic ultrasound-guided fine needle aspiration and biopsy using a 22-gauge needle with side fenestration in pancreatic cystic lesions.

    Science.gov (United States)

    Barresi, Luca; Tarantino, Ilaria; Traina, Mario; Granata, Antonino; Curcio, Gabriele; Azzopardi, Neville; Baccarini, Paola; Liotta, Rosa; Fornelli, Adele; Maimone, Antonella; Jovine, Elio; Cennamo, Vincenzo; Fabbri, Carlo

    2014-01-01

    Cytologic diagnosis by endoscopic ultrasound-guided fine needle aspiration is associated with low sensitivity and adequacy. A newly designed endoscopic ultrasound-guided fine needle biopsy device, endowed with a side fenestration, is now available. We carried out a study with the aim of evaluating the feasibility, safety, and diagnostic yield of the 22-gauge needle with side fenestration for endoscopic ultrasound fine needle aspiration and biopsy of pancreatic cystic lesions. 58 patients with 60 pancreatic cystic lesions consecutively referred for endoscopic ultrasound guided-fine needle aspiration were enrolled in a prospective, dual centre study, and underwent fine needle aspiration and biopsy with the 22-gauge needle with side fenestration. Fine needle aspiration and biopsy was technically feasible in all cases. In 39/60 (65%) pancreatic cystic lesions, the specimens were adequate for cyto-histologic assessment. In lesions with solid components, and in malignant lesions, adequacy was 94.4% (p = 0.0149) and 100% (p = 0.0069), respectively. Samples were adequate for histologic evaluation in 18/39 (46.1%) cases. There were only 2 (3.3%) mild complications. Fine needle aspiration and biopsy with the 22-gauge needle with side fenestration is feasible, and superior to conventional endoscopic ultrasound-guided fine needle aspiration cytology from cystic fluid, particularly in pancreatic cystic lesions with solid component or malignancy, with a higher diagnostic yield and with no increase in complication rate. Copyright © 2013 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

  12. Aspiration thrombectomy in a case of acute myocardial infarction due to coronary emboli in a patient with peripartum cardiomyopathy and mural thrombus.

    Science.gov (United States)

    Abdulbaki, Abdulrahman; Kocherla, Cyrus; Modi, Kalgi

    2015-01-01

    Acute coronary syndrome (ACS) due to embolic phenomenon in the setting of peripartum cardiomyopathy (PPCM) and left ventricular mural thrombus is a rare occurrence. There have been two known cases described in medical literature. We present a unique case in which catheter-based aspiration thrombectomy was used to successfully treat a patient with ACS due to coronary emboli in the setting of PPCMand left ventricular mural thrombus. We believe this to be the first report of the use of aspiration thrombectomy in such a clinical case.

  13. Aspiration thrombectomy in a case of acute myocardial infarction due to coronary emboli in a patient with peripartum cardiomyopathy and mural thrombus

    Directory of Open Access Journals (Sweden)

    Abdulrahman Abdulbaki

    2016-02-01

    Full Text Available Acute coronary syndrome (ACS due to embolic phenomenon in the setting of peripartum cardiomyopathy (PPCM and left ventricular mural thrombus is a rare occurrence. There have been two known cases described in medical literature. We present a unique case in which catheter-based aspiration thrombectomy was used to successfully treat a patient with ACS due to coronary emboli in the setting of PPCMand left ventricular mural thrombus. We believe this to be the first report of the use of aspiration thrombectomy in such a clinical case.

  14. A student surgical society – the Cape Town experience

    African Journals Online (AJOL)

    The UCT Surgical Society is a student-managed academic society that promotes ... curricular surgical lectures and clinical activities for their medical students, all with the ... accommodate all in attendance (talks regularly attract 200 - 300 attendees). ... at any institution: all that is needed is a group of motivated, hard- working ...

  15. Diagnostic Value of Processing Cytologic Aspirates of Renal Tumors in Agar Cell (Tissue) Blocks

    DEFF Research Database (Denmark)

    Smedts, F.; Schrik, M.; Horn, T.

    2010-01-01

    smears were prepared after each aspiration for conventional cytology and the remaining aspirate was processed for the improved agar microbiopsy (AM) method. Conventional cytology slides, AM slides and surgical specimens were diagnosed separately, after which the diagnoses were compared....... Immunohistochemistry was performed as required on the AM sections. Surgical specimens served as the gold standard. Results In 53% of conventional cytologic smears, the cellular yield was sufficient to render a correct diagnosis. In 12% the diagnosis was incorrect, in 21% only a differential diagnosis could be fin......-initiated, and in 14% too few diagnostic cells were present in the conventional smears for cytologic diagnosis. It was, however, possible to correctly diagnose histologic sections from 97% of AM tissue blocks. In 11 cases this was facilitated with immunochemistry. In only 1 case did the AM tissue block contain too few...

  16. Bone marrow aspirate concentrate in combination with intravenous iloprost increases bone healing in patients with avascular necrosis of the femoral head: a matched pair analysis

    Directory of Open Access Journals (Sweden)

    Hakan Pilge

    2017-01-01

    Full Text Available With disease progression, avascular necrosis (AVN of the femoral head may lead to a collapse of the articular surface. The exact pathophysiology of AVN remains unclear, although several conditions are known that can result in spontaneous cell death, leading to a reduction of trabecular bone and the development of AVN. Hip AVN treatment is stage-dependent in which two main stages of the disease can be distinguished: pre-collapse (ARCO 0-II and post-collapse stage (ARCO III-IV, crescent sign. In the pre-collapse phase, core decompression (CD, with or without the addition of bone marrow (e.g. bone marrow aspirate concentrate, BMAC or bone graft, is a common treatment alternative. In the postcollapse phase, THA (total hip arthroplasty must be performed in most of the patients. In addition to surgical treatment, the intravenous application of Iloprost has been shown to have a curative potential and analgesic effect. From October 2009 to October 2014, 49 patients with AVN (stages I-III were treated with core decompression at our institution. All patients were divided into group A (CD + BMAC and group B (CD alone. Of these patients, 20 were included in a matched pair analysis. The patients were matched to age, gender, ARCO-stage, Kerboul combined necrotic angle, the cause of AVN, and whether Iloprost-therapy was performed. The Merle d’Aubigné Score and the Kerboul combined necrotic angle in a-p and lateral radiographs were evaluated pre- and postoperatively. The primary endpoint was a total hip arthroplasty. In group A, two patients needed THA while in group B four patients were treated with THA. In group A, the Merle d’Aubigné Score improved from 13.5 (pre-operatively to 15.3 (postoperatively. In group B there was no difference between the pre- (14.3 and postoperative (14.1 assessment. The mean of the Kerboul angle showed no difference in both groups compared pre- to postoperatively (group A: pre-op 212°, postop 220°, group B: pre-op 213

  17. Endoscopic quadricepsplasty: A new surgical technique.

    Science.gov (United States)

    Blanco, C E; Leon, H O; Guthrie, T B

    2001-05-01

    We present a new surgical subperiosteal endoscopic technique for the release of fibrosis of the quadriceps to the femur caused by gunshot injuries, postsurgical scarring, and fractures, that was developed at the Arthroscopy Group at Hospital Hermanos Ameijeiras in Havana, Cuba. The technique used is a proximal endoscopic subperiosteal extension of the usual arthroscopic intra-articular release of adhesions, using periosteal elevators and arthroscopic scissors placed through medial and lateral superior knee portals to release adhesions and bands of scar tissue beneath the quadriceps mechanism. The technique was used in a prospective case series of 26 male patients aged 19 to 22 years between February 1997 and March 1998 who presented with clinically and ultrasonically documented extra-articular fibrosis resulting in ankylosis of the knee in extension. Only patients who had reached a plateau in their aggressive physiotherapy program with no further progression in knee flexion for 3 months were selected. Those with joint instability, motion-limiting articular surface pathology, and muscle or neurologic injury were excluded. All patients had obtained satisfactory results at 2-year follow-up. The extra-articular release gained at final follow-up was between 30 degrees and 90 degrees of flexion in addition to that obtained at the completion of the standard intra-articular release. Complications included 1 case of deep vein thrombosis, 2 cases of scrotal edema, 5 cases of hemarthrosis, and 2 cases of reflex sympathetic dystrophy. We have found this technique useful in obtaining additional flexion and improved function in a difficult class of patients with ankylosis caused by extra-articular fibrosis of the quadriceps to the femur, allowing immediate aggressive rehabilitation and presenting a useful outpatient alternative with fewer and less severe complications than described with the classic open Thompson's quadricepsplasty.

  18. Ultrasound-guided aspiration and steroid injection of a posterior cruciate ligament ganglion cyst: report of a case.

    Science.gov (United States)

    Vilella, Giuseppe Maria; Guerrisi, Pietro; Lucignani, Giulia; Pasquali, Gaia; Drudi, Francesco Maria

    2015-09-01

    Ganglion cysts are benign masses that originate from mucinous degeneration of the connective tissues and are quite rare when arising from the knee joint. Symptoms are often represented by pain, joint tenderness, effusion and occasional swelling with a palpable mass in the popliteal region of the knee. Percutaneous aspiration followed by a corticosteroid injection of a ganglion cyst has either a diagnostic or therapeutic meaning and its guidance through ultrasound allows the operator to make more accurate the procedure, ensuring the correct placement of the needle inside the lesion. We report our experience in the treatment of a voluminous ganglion cyst of the posterior cruciate ligament performed through the ultrasound guidance in a symptomatic young patient.

  19. Haptic feedback and control of a flexible surgical endoscopic robot.

    Science.gov (United States)

    Wang, Zheng; Sun, Zhenglong; Phee, Soo Jay

    2013-11-01

    A flexible endoscope could reach the potential surgical site via a single small incision on the patient or even through natural orifices, making it a very promising platform for surgical procedures. However, endoscopic surgery has strict spatial constraints on both tool-channel size and surgical site volume. It is therefore very challenging to deploy and control dexterous robotic instruments to conduct surgical procedures endoscopically. Pioneering endoscopic surgical robots have already been introduced, but the performance is limited by the flexible neck of the robot that passes through the endoscope tool channel. In this article we present a series of new developments to improve the performance of the robot: a force transmission model to address flexibility, elongation study for precise position control, and tissue property modeling for haptic feedback. Validation experiment results are presented for each sector. An integrated control architecture of the robot system is given in the end. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  20. Managerial implications and suitability of a master surgical scheduling approach

    NARCIS (Netherlands)

    J.M. van Oostrum (Jeroen); E. Bredenhoff (Eelco); E.W. Hans (Erwin)

    2008-01-01

    textabstractMaster surgical scheduling can improve manageability and efficiency of operating room departments. This approach cyclically executes a master surgical schedule of surgery types. These surgery types need to be constructed with low variability to be efficient. Each surgery type is schedule

  1. Managerial implications and suitability of a master surgical scheduling approach

    NARCIS (Netherlands)

    J.M. van Oostrum (Jeroen); E. Bredenhoff (Eelco); E.W. Hans (Erwin)

    2008-01-01

    textabstractMaster surgical scheduling can improve manageability and efficiency of operating room departments. This approach cyclically executes a master surgical schedule of surgery types. These surgery types need to be constructed with low variability to be efficient. Each surgery type is

  2. Clinical profile of children with kerosene aspiration.

    Science.gov (United States)

    Venkatesh, C; Sriram, P; Adhisivam, B; Mahadevan, S

    2011-07-01

    Accidental aspiration of kerosene is a common problem among children in developing countries. This descriptive study involved the retrospective analysis of children admitted with kerosene aspiration in a tertiary care hospital in South India for a year. Kerosene aspiration contributed to 60.4% of poisoning cases. Boys aged less than three years and from a rural background formed a significant proportion. Tachypnoea, cough and crepitations were the predominant clinical findings. Male gender and malnutrition (weight for age <80%) were significantly associated with prolonged hospital stay.

  3. [A case of bronchial foreign body due to citrus fruit seed aspiration showing multiple pulmonary infiltration repeatedly].

    Science.gov (United States)

    Morimatsu, Yoshitaka; Aoki, Yuka; Mizoguchi, Yusuke; Kitasato, Hirohiko; Aizawa, Hisamichi

    2005-12-01

    We report a case of a bronchial foreign body in a 76-year-old citrus fruit farmer. The patient was detected patchy infiltration (ground-glass attenuation) of the right upper lung field on the chest X-ray on Dec. 26th, 2003. The shadow tended to disappear after treatment with antibiotics. The same shadow was detected again 10 months later and the patient underwent a bronchoscopic examination. A foreign body was found lodged in the center of the right upper bronchus, associated with bronchial stenosis due to mucosal edema. The abnormal shadow disappeared after the foreign body, which we decided was a citrus fruit seed, was removed. From the time course of the present illness and a retrospective evaluation of previous chest X-rays, the patient had aspirated the foreign body 18 months prior to his admission for bronchoscopy. We should be careful of the possibility of foreign bodies even when the elderly do not present a history of foreign body aspiration. It is important to consider the possibility of a bronchial foreign body in patients with repeated pneumonia, and to perform bronchoscopy aggressively.

  4. [Usefulness of endoscopically guided nasogastric-jejunal feeding tube placement in a case of aspiration pneumonia due to postgastrectomy].

    Science.gov (United States)

    Tamura, Kosei; Totsuka, Osamu; Tamura, Jun'ichi

    2015-01-01

    A 79-year-old man with a history of gastrectomy with Billroth II reconstruction 27 years previously was admitted to our hospital due to recurrent pneumonia. Because he had dysphagia and had frequently developed pneumonia over the course of a year, enteral nutrition via nasogastric tube was initiated approximately six months before admission. The clinical and computed tomography findings showed that the cause of pneumonia was aspiration of tube feeding nutrients due to gastroesophageal reflux. To prevent gastroesophageal reflux, he was continuously kept in a 30-degree or greater reclining position. However, gastroesophageal reflux was seen at an injection rate of 50 ml/h or greater. After we inserted a nasogastric-jejunal feeding tube guided by endoscopy, gastroesophageal reflux, dumping syndrome and diarrhea were not seen up to an injection rate of 300 ml/h. Endoscopically guided nasogastric-jejunal feeding tube placement is a simple method and may be useful for patients with aspiration pneumonia due to postgastrectomy. Moreover, long-term postgastrectomy patients appear to tolerate the postopyloric injection of enteral nutrition. Because the number of elderly patients who have dysphagia with postgastrectomy is increasing, these findings provide a basis for treatment in elderly medical settings.

  5. Successful aspiration and ethanol sclerosis of a large, symptomatic, simple liver cyst: Case presentation and review of the literature

    Institute of Scientific and Technical Information of China (English)

    Wojciech C Blonski; Mical S Campbell; Thomas Faust; David C Metz

    2006-01-01

    Simple liver cysts are congenital with a prevalence of 2.5%-4.25%. Imaging, whether by US, CT or MRI,is accurate in distinguishing simple cysts from other etiologies, including parasitic, neoplastic, duct-related,and traumatic cysts. Symptomatic simple liver cysts are rare, and the true frequency of symptoms is not known.Symptomatic simple liver cysts are predominantly large (> 4 cm), right-sided, and more common in women and older patients. The vast majority of simple hepatic cysts require no treatment or follow-up, though large cysts (> 4 cm) may be followed initially with serial imaging to ensure stability. Attribution of symptoms to a large simple cyst should be undertaken with caution, after alternative diagnoses have been excluded. Aspiration may be performed to test whether symptoms are due to the cyst; however, cyst recurrence should be expected.Limited experience with both laparoscopic deroofing and aspiration, followed by instillation of a sclerosing agent has demonstrated promising results for the treatment of symptomatic cysts. Here, we describe a patient with a large, symptomatic, simple liver cyst who experienced complete resolution of symptoms following cyst drainage and alcohol ablation, and we present a comprehensive review of the literature.

  6. Coronary air embolism treated with aspiration catheter.

    Science.gov (United States)

    Patterson, M S; Kiemeneij, F

    2005-05-01

    Coronary air embolism remains a recognised complication of coronary catheterisation despite a strong emphasis on prevention. Current treatment consists of supportive measures with 100% oxygen and analgesia. Recent case reports describe the use of mechanical treatments aimed at dispersing or removing the air embolus with variable success. A case of coronary air embolism causing an acute coronary syndrome is described that was definitively treated with an aspiration system. The effectiveness of the aspiration system in the distal section of an obtuse marginal artery indicates that such dedicated aspiration systems may prove useful in the standard treatment of air embolism.

  7. Cervical auscultation in the diagnosis of oropharyngeal aspiration in children: a study protocol for a randomised controlled trial.

    Science.gov (United States)

    Frakking, Thuy T; Chang, Anne B; O'Grady, Kerry-Ann F; Walker-Smith, Katie; Weir, Kelly A

    2013-11-07

    Oropharyngeal aspiration (OPA) can lead to recurrent respiratory illnesses and chronic lung disease in children. Current clinical feeding evaluations performed by speech pathologists have poor reliability in detecting OPA when compared to radiological procedures such as the modified barium swallow (MBS). Improved ability to diagnose OPA accurately via clinical evaluation potentially reduces reliance on expensive, less readily available radiological procedures. Our study investigates the utility of adding cervical auscultation (CA), a technique of listening to swallowing sounds, in improving the diagnostic accuracy of a clinical evaluation for the detection of OPA. We plan an open, unblinded, randomised controlled trial at a paediatric tertiary teaching hospital. Two hundred and sixteen children fulfilling the inclusion criteria will be randomised to one of the two clinical assessment techniques for the clinical detection of OPA: (1) clinical feeding evaluation only (CFE) group or (2) clinical feeding evaluation with cervical auscultation (CFE + CA) group. All children will then undergo an MBS to determine radiologically assessed OPA. The primary outcome is the presence or absence of OPA, as determined on MBS using the Penetration-Aspiration Scale. Our main objective is to determine the sensitivity, specificity, negative and positive predictive values of 'CFE + CA' versus 'CFE' only compared to MBS-identified OPA. Early detection and appropriate management of OPA is important to prevent chronic pulmonary disease and poor growth in children. As the reliability of CFE to detect OPA is low, a technique that can improve the diagnostic accuracy of the CFE will help minimise consequences to the paediatric respiratory system. Cervical auscultation is a technique that has previously been documented as a clinical adjunct to the CFE; however, no published RCTs addressing the reliability of this technique in children exist. Our study will be the first to establish the utility

  8. Training Surgical Residents With a Haptic Robotic Central Venous Catheterization Simulator.

    Science.gov (United States)

    Pepley, David F; Gordon, Adam B; Yovanoff, Mary A; Mirkin, Katelin A; Miller, Scarlett R; Han, David C; Moore, Jason Z

    2017-06-20

    Ultrasound guided central venous catheterization (CVC) is a common surgical procedure with complication rates ranging from 5 to 21 percent. Training is typically performed using manikins that do not simulate anatomical variations such as obesity and abnormal vessel positioning. The goal of this study was to develop and validate the effectiveness of a new virtual reality and force haptic based simulation platform for CVC of the right internal jugular vein. A CVC simulation platform was developed using a haptic robotic arm, 3D position tracker, and computer visualization. The haptic robotic arm simulated needle insertion force that was based on cadaver experiments. The 3D position tracker was used as a mock ultrasound device with realistic visualization on a computer screen. Upon completion of a practice simulation, performance feedback is given to the user through a graphical user interface including scoring factors based on good CVC practice. The effectiveness of the system was evaluated by training 13 first year surgical residents using the virtual reality haptic based training system over a 3 month period. The participants' performance increased from 52% to 96% on the baseline training scenario, approaching the average score of an expert surgeon: 98%. This also resulted in improvement in positive CVC practices including a 61% decrease between final needle tip position and vein center, a decrease in mean insertion attempts from 1.92 to 1.23, and a 12% increase in time spent aspirating the syringe throughout the procedure. A virtual reality haptic robotic simulator for CVC was successfully developed. Surgical residents training on the simulation improved to near expert levels after three robotic training sessions. This suggests that this system could act as an effective training device for CVC. Copyright © 2017 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

  9. Diagnosis of Aelurostrongylus abstrusus verminous pneumonia via sonography-guided fine-needle pulmonary parenchymal aspiration in a cat

    Directory of Open Access Journals (Sweden)

    Jennifer Gambino

    2016-04-01

    Full Text Available Case summary A 9-year-old, male neutered, indoor–outdoor domestic shorthair cat from the northern Alabama countryside presented for a 3 week history of coughing, lethargy and an episode of self-resolving dyspnea that occurred 1 week prior to presentation. Three-view thoracic radiographs revealed a moderate-to-severe, diffuse, mixed bronchial to structured interstitial (miliary-to-nodular pulmonary pattern in all lung lobes with peribronchial cuffing and multifocal areas of mild patchy alveolar opacity. Ultrasound-guided evaluation and fine-needle aspiration of the caudodorsal lung parenchyma was performed with sedation. Cytology revealed many widely scattered Aelurostrongylus abstrusus larvae and ova. Upon the confirmed diagnosis of A abstrusus verminous pneumonia, treatment with fenbendazole and selamectin resulted in complete resolution of clinical signs within 6 weeks of the initial diagnosis. Relevance and novel information We report herein the first documented case in the Americas of A abstrusus verminous pneumonia diagnosed via cytologic evaluation of an in vivo, percutaneous ultrasound-guided fine-needle aspirate of affected lung. Additionally, to our knowledge, we offer the first account of the sonographic (pulmonary features of the disease.

  10. The application of digital surgical diagnosis and treatment technology: a promising strategy for surgical reconstruction of craniomaxillofacial defect and deformity.

    Science.gov (United States)

    Wang, Li-ya; Du, Hong-ming; Zhang, Gang; Tang, Wei; Liu, Lei; Jing, Wei; Long, Jie

    2011-12-01

    The craniomaxillofacial defect and deformity always leads to serious dysfunction in mastication and facial contour damage, significantly reducing patients' quality of life. However, surgical reconstruction of a craniomaxillofacial hard tissue defect or deformity is extremely complex and often does not result in desired facial morphology. Improving the result for patients with craniomaxillofacial defect and deformity remains a challenge for surgeons. Using digital technology for surgical diagnosis and treatment may help solve this problem. Computer-assisted surgical technology and surgical navigation technology are included in the accurate digital diagnosis and treatment system we propose. These technologies will increase the accuracy of the design of the operation plan. In addition, the intraoperative real-time navigating location system controlling the robotic arm or advanced intelligent robot will provide accurate, individualized surgical treatment for patients. Here we propose the hypothesis that a digital surgical diagnosis and treatment technology may provide a new approach for precise surgical reconstruction of complicated craniomaxillofacial defect and deformity. Our hypothesis involves modern digital surgery, a three-dimensional navigation surgery system and modern digital imaging technology, and our key aim is to establish a technological platform for customized digital surgical design and surgical navigation for craniomaxillofacial defect and deformity. If the hypothesis is proven practical, this novel therapeutic approach could improve the result of surgical reconstruction for craniomaxillofacial defect and deformity for many patients.

  11. The accuracy of fine-needle aspiration cytology for diagnosis of parotid gland masses: a clinicopathological study of 114 patients

    Science.gov (United States)

    GUDMUNDSSON, Jens Kristjan; AJAN, Aida; ABTAHI, Jahan

    2016-01-01

    ABSTRACT Objective Fine-needle aspiration cytology is a valuable method for preoperative assessment of head and neck tumors. However, its accuracy in detection of salivary gland masses is controversial compared with other methods. The aim of this work was to evaluate the effectiveness and accuracy of fine-needle aspiration cytology (FNAC) in the diagnosis of parotid gland masses. Material and Methods Over a 10-year period, 126 parotid gland masses were resected. Retrospective chart reviews of 114 patients were performed. The results of FNAC and final histological diagnosis were compared and the accuracy of FNAC was determined. Results Final histological evaluation revealed 11 malignant tumors and 103 benign lesions. Pleomorphic adenoma was the most common neoplasm (63%), followed by Warthin’s tumor (17.5%). The sensitivity of FNAC in detecting malignant tumors was 73% and the specificity was 97%. Positive predictive value (PPV) was 73% and negative predictive value (NPV) was 97%. The overall accuracy of FNAC in detecting parotid masses was 95%. False-negative diagnosis was found in mucoepidermoid carcinoma, acinic cell carcinoma, and epithelial-myoepithelial carcinoma whereas there was false-positive diagnosis in cases of pleomorphic adenoma and normal parotid gland tissue. Conclusion FNAC is a reliable minimally invasive diagnostic method with a high sensitivity in diagnosis of lesions in parotid glands. The sensitivity of detection of malignant tumors in parotid glands was low due to the biopsy technique used, and depended on tumor location. Postoperative complications decreased after superficial parotidectomy. PMID:28076460

  12. The accuracy of fine-needle aspiration cytology for diagnosis of parotid gland masses: a clinicopathological study of 114 patients

    Directory of Open Access Journals (Sweden)

    Jens Kristjan GUDMUNDSSON

    Full Text Available ABSTRACT Objective Fine-needle aspiration cytology is a valuable method for preoperative assessment of head and neck tumors. However, its accuracy in detection of salivary gland masses is controversial compared with other methods. The aim of this work was to evaluate the effectiveness and accuracy of fine-needle aspiration cytology (FNAC in the diagnosis of parotid gland masses. Material and Methods Over a 10-year period, 126 parotid gland masses were resected. Retrospective chart reviews of 114 patients were performed. The results of FNAC and final histological diagnosis were compared and the accuracy of FNAC was determined. Results Final histological evaluation revealed 11 malignant tumors and 103 benign lesions. Pleomorphic adenoma was the most common neoplasm (63%, followed by Warthin’s tumor (17.5%. The sensitivity of FNAC in detecting malignant tumors was 73% and the specificity was 97%. Positive predictive value (PPV was 73% and negative predictive value (NPV was 97%. The overall accuracy of FNAC in detecting parotid masses was 95%. False-negative diagnosis was found in mucoepidermoid carcinoma, acinic cell carcinoma, and epithelial-myoepithelial carcinoma whereas there was false-positive diagnosis in cases of pleomorphic adenoma and normal parotid gland tissue. Conclusion FNAC is a reliable minimally invasive diagnostic method with a high sensitivity in diagnosis of lesions in parotid glands. The sensitivity of detection of malignant tumors in parotid glands was low due to the biopsy technique used, and depended on tumor location. Postoperative complications decreased after superficial parotidectomy.

  13. [Noma. Proposal for a surgical treatment].

    Science.gov (United States)

    Martin, D; Pinsolle, V; Pelissier, Ph; Barthelemy, I; Weis, C; Baudet, J

    2004-06-01

    The authors present their experience of surgical treatment of noma in situation of surgical camp. The strategy is focused on two objectives: treatment of tissue loss itself and treatment of the trismus. After having presented the means at disposal, going from local flaps, quickly exceeded, to distant flaps, they decided upon the indications by taking in account the NOILTULP classification. Thus, the authors present their experience of fascia temporalis skin grafted for oral lining in combination with the submental or Backamjian flap for external coverage. The treatment of the trismus is less codified requiring osteotomies in stages 3 and 4. They finally insist first on the prevention of this disease, very accessible to antibiotics at the initial stage of stomatitis and second on simple means very efficient to prevent the trismus which impairs heavily the functional outcome of the reconstructions.

  14. A cell pattern approach to interpretation of fine needle aspiration cytology of thyroid lesions: A cyto-histomorphological study

    Directory of Open Access Journals (Sweden)

    Bommanahalli Basavaraj

    2010-01-01

    Full Text Available Aim: Our study aimed at a cell pattern approach to interpret thyroid cytology and to demonstrate diagnostic accuracy of fine needle aspiration cytology (FNAC with an emphasis on diagnostic pitfalls. Materials and Methods: A total number of 218 goitre cases, from the year 2000 to 2004, were reviewed retrospectively from the cytology files, without considering the previous cytological diagnosis. Four cases with inadequate aspirate were excluded. The predominant cell pattern, such as macro/normofollicular, microfollicular, papillary, syncytial, dispersed and cystic pattern, was noted in each case. The final diagnosis was arrived by observing the cellular details and background elements. Cytological diagnosis was correlated with histopathology in 75 cases. The sensitivity and specificity were computed. Results: Normo/macrofollicular pattern was seen in 71.96% of nodular goitre and 6.9% of follicular neoplasms. Around 86.2% of follicular neoplasms and 17.6% of papillary carcinoma had microfollicular pattern. The papillary pattern was seen in 47% of papillary carcinoma. Syncytial pattern was noticed in 72.3% of chronic lymphocytic thyroiditis and 29.4% of papillary carcinoma. Cytological diagnosis was concordant with histopathological diagnosis in 65 cases. Overall sensitivity and specificity of FNAC in diagnosing neoplastic lesions of thyroid were 83.33 and 95.55%, respectively. Conclusion: FNAC is more sensitive and specific in triaging neoplastic from non-neoplastic thyroid lesions. Identification of the predominant cell pattern would be complementary to analysis of cell morphology and background details in cytological diagnosis of thyroid lesions. This approach helps to diagnose follicular neoplasm and follicular variant of papillary thyroid carcinoma.

  15. Evolution of surgical therapy for Stanford acute type A aortic dissection.

    Science.gov (United States)

    Chiu, Peter; Miller, D Craig

    2016-07-01

    Acute type A aortic dissection (AcA-AoD) is a surgical emergency associated with very high morbidity and mortality. Unfortunately, the early outcome of emergency surgical repair has not improved substantially over the last 20 years. Many of the same debates occur repeatedly regarding operative extent and optimal conduct of the operation. The question remains: are patients suffering from too large an operation or too small? The pendulum favoring routine aortic valve resuspension, when feasible, has swung towards frequent aortic root replacement. This already aggressive approach is now being challenged with the even more extensive valve-sparing aortic root replacement (V-SARR) in selected patients. Distally, open replacement of most of the transverse arch is best in most patients. The need for late aortic re-intervention has not been shown to be affected by more extensive distal operative procedures, but the contemporary enthusiasm for a distal frozen elephant trunk (FET) only seems to build. It must be remembered that the first and foremost goal of the operation is to have an operative survivor; additional measures to reduce late morbidity are secondary aspirations. With increasing experience, true contraindications to emergency surgical operation have dwindled, but patients with advanced age, multiple comorbidities, and major neurological deficits do not fare well. The endovascular revolution, moreover, has spawned innovative options for modern practice, including ascending stent graft and adaptations of the old flap fenestration technique. Despite the increasingly complex operations and ever expanding therapies, this life-threatening disease remains a stubborn challenge for all cardiovascular surgeons. Development of specialized thoracic aortic teams and regionalization of care for patients with AcA-AoD offers the most promise to improve overall results.

  16. A Design Approach for an Innovative LED Surgical Light

    Science.gov (United States)

    Hadrath, Stefan; Morgenbrod, Nico

    2014-12-01

    We will present a design approach for a surgical light consisting of a central high-power LED module and a metal-free TIR reflector. The reflector's surface is designed as a grooved surface providing two TIR reflections.

  17. Metastasis of colon cancer to the thyroid gland: a case diagnosed on fine-needle aspirate by a combined cytological, immunocytochemical, and molecular approach.

    Science.gov (United States)

    Cozzolino, Immacolata; Malapelle, Umberto; Carlomagno, Chiara; Palombini, Lucio; Troncone, Giancarlo

    2010-12-01

    Fine-needle aspiration (FNA) with cytological evaluation reliably diagnoses primary and secondary thyroid neoplasms. However, identifying the primary origin of a metastatic process involving the thyroid gland is challenging. In particular, metastasis of colon cancer to the thyroid gland is very rare. In this case report, a right lobe solid thyroid nodule in a 66-year-old male was aspirated. FNA cytology showed necrosis and atypical tall columnar cells; since, the patient at age 60 had undergone surgery for a sigmoid-rectal cancer metastasizing to the liver and subsequently to the lung, a suspicion of metastasis from colon cancer was raised. This was corroborated by cell-block immunocytochemistry showing a cytokeratin (CK) 7 negative/CK20-positive staining pattern; thyreoglobulin and TTF-1 were both negative. Since KRAS codon 12/13 mutations frequently occur in colon cancer, whereas they are extremely uncommon in primary thyroid tumors, DNA was extracted from the aspirated cells, and KRAS mutational analysis was carried out. The codon 12 G12D mutation was found; the same mutation was evident in the primary cancer of the colon and in its liver and lung metastasis. Thus, a combined cytological, immunocytochemical and molecular approach unquestionably correlated metastatic adenocarcinoma cells aspirated from the thyroid to a colo-rectal origin.

  18. Stereolithography in oral implantology: a comparison of surgical guides.

    Science.gov (United States)

    Sammartino, Gilberto; Della Valle, Antonio; Marenzi, Gaetano; Gerbino, Salvatore; Martorelli, Massimo; di Lauro, Alessandro Espedito; di Lauro, Francesco

    2004-06-01

    This article presents the use of stereolithography in oral implantology. Stereolithography is a new technology that can produce physical models by selectively solidifying an ultraviolet-sensitive liquid resin using a laser beam, reproducing the true maxillary and mandibular anatomic dimensions. With these models, it is possible to fabricate surgical guides that can place the implants in vivo in the same places and same directions as those in the planned computer simulation. A 70-year-old woman, in good health, with severe mandibular bone atrophy was rehabilitated with an over-denture supported by 2 Branemark implants. Two different surgical planning methods were considered: 1) the construction of a surgical guide evaluating clinical aspects, and 2) the surgical guide produced by stereolithographic study. The accuracy of surgical planning can reduce the problems related to bone density and dimensions. Furthermore, the stereolithographic study assured the clinicians of a superior location of fixtures in bone. Surgical planning based on stereolithographic technique is a safe procedure and has many advantages. This technologic advance has biologic and therapeutic benefits because it simplifies anatomic surgical management for improved implant placement.

  19. A Randomized Study of Three Interventions for Aspiration of Thin Liquids in Patients with Dementia or Parkinson's Disease

    Science.gov (United States)

    Logemann, Jeri A.; Gensler, Gary; Robbins, JoAnne; Lindblad, Anne S.; Brandt, Diane; Hind, Jacqueline A.; Kosek, Steven; Dikeman, Karen; Kazandjian, Marta; Gramigna, Gary D.; Lundy, Donna; McGarvey-Toler, Susan; Miller Gardner, Patricia J.

    2008-01-01

    Purpose: This study was designed to identify which of 3 treatments for aspiration on thin liquids--chin-down posture, nectar-thickened liquids, or honey-thickened liquids--results in the most successful immediate elimination of aspiration on thin liquids during the videofluorographic swallow study in patients with dementia and/or Parkinson's…

  20. Development of a vision integration framework for laparoscopic surgical robot.

    Science.gov (United States)

    Shin, Jung W; Park, Jun W; Lee, Chul H; Hong, Soyoung; Jo, Yungho; Choi, Jaesoon

    2006-01-01

    In order to realize intelligent laparoscopic surgical robot, a vision integrated system constitutes one of the fundamental components. The authors have constructed a vision framework in the current version of NCC (National Cancer Center) laparoscopic surgical robot controlled on a real-time OS (RTLinux-Pro, FSMLabs Inc., U.S.A.). Adding vision framework, we have been applying and testing image processing algorithms- edge detection of object for positioning surgical tool, Watersheds for recognizing object. This paper documents the implementation of the framework and preliminary results of the image segmentation using Watersheds algorithm. Finally the real-time processing capability of our vision system is discussed.

  1. Collision tumor of primary merkel cell carcinoma and chronic lymphocytic leukemia/small lymphocytic lymphoma, diagnosed on ultrasound-guided fine-needle aspiration biopsy: a unique case report and review of literature.

    Science.gov (United States)

    Li, Zhonghua; Yang, Jing-Jing; Wu, Maoxin

    2015-01-01

    We report an extremely rare case of skin collision tumor between primary Merkel cell carcinoma (MCC) and chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) first diagnosed on ultrasound-guided fine-needle aspiration biopsy (US-FNA). A 95-year-old female with a history of CLL presented with a slow growing left malar mass was referred to our clinic for US-FNA. US scan showed a well-defined subcutaneous mass (2.78 cm) with complex echogenicity. On-site assessment showed a cellular aspiration which was interpreted as small blue round cell tumor. On further examination, smears and cell block showed dimorphic populations of relatively larger cells with neuroendocrine features and smaller lymphoid cells. Immunocytochemical studies of cell block sections revealed that the larger cells were positive for CD56, Chromogranin, Synaptophysin, CK8/18, CK20 (dot-like pattern); and the smaller cells were positive for CD45. Flow cytometric analysis showed a majority of CD16/CD56 positive cells, 17% of monoclonal B-cells, and 14% of reactive T cells. The immunophenotype of the monoclonal B cells were of CLL/SLL. The diagnosis of a collision tumor composed of primary MCC and CLL/SLL was confirmed. Surgical resection of the mass one month later concurred with the FNA cytological diagnosis. The fact that surgical specimen displayed a solid tumor with both CLL/SLL and MCC components ruled out the possibility that the FNA merely had MCC with peripheral leukemic blood contaminant. No additional MCC lesion was found in the patient, which ruled out the possibility of metastatic MCC to a lymphomatous lymph node. © 2014 Wiley Periodicals, Inc.

  2. Communication as a core skill of palliative surgical care.

    Science.gov (United States)

    Miner, Thomas J

    2012-03-01

    Excellence as a surgeon requires not only the technical and intellectual ability to effectively take care of surgical disease but also an ability to respond to the needs and questions of patients. This article provides an overview of the importance of communication skills in optimal surgical palliation and offers suggestions for a multidisciplinary team approach, using the palliative triangle as the ideal model of communication and interpersonal skills. This article also discusses guidelines for advanced surgical decision making and outlines methods to improve communication skills.

  3. A fine needle aspiration cytology in time saves nine” — cutaneous phaeohyphomycosis caused by Exophiala jeanselmei in a renal transplant patient: Diagnosis by fine needle aspiration cytology

    Science.gov (United States)

    Joshi, Prashant; Agarwal, Shipra; Singh, Geetika; Xess, Immaculata; Bhowmik, Dipankar

    2016-01-01

    Infections by dematiaceous fungi are an emerging group of infectious diseases worldwide with a variety of clinical presentations. Though generally localized, they can disseminate in immunocompromised settings, therefore, early diagnosis and prompt therapy can prevent significant morbidity and mortality in these patients. Fungi of genus Exophiala are common causative organisms; however, Exophiala jeanselmei (E. jeanselmei) has not yet been reported from environmental sources in India. We present here the case of a renal transplant recipient who presented with an innocuous lesion on the foot, diagnosed on fine needle aspiration cytology (FNAC) as phaeohyphomycosis, and promptly treated with excision and antifungal therapy. To the best of our knowledge, this is the first case report from India of E. jeanselmei causing phaeohyphomycosis in a transplant recipient and highlights the role a cytopathologist can play in the timely management of such cases. PMID:27011447

  4. Feasibility of fine-needle aspiration biopsy and its applications in superficial cervical lesion biopsies.

    Science.gov (United States)

    Xu, Dong; Xu, Hai-Miao; Li, Ming-Kui; Chen, Li-Yu; Wang, Li-Jing

    2014-01-01

    The aim of the study was to investigate the feasibility and value of clinical application of fine-needle aspiration histological biopsy via ultrasound-guided thyroid nodule and enlarged cervical lymph node fine-needle aspiration histological biopsy. Fine-needle aspiration cytological and histological biopsies and surgical treatments were performed on 982 patients with thyroid nodule and 1435 patients with enlarged cervical lymph nodes. A comparative study of the histological and cytological examination results and post-surgical etiology results was subsequently conducted. Among the 982 thyroid nodule patients, the acquisition rates were 89.8% (882/982) for fine-needle aspiration histological biopsy and 96.2% (945/982) for cytological biopsy, while among the 1435 patients with enlarged cervical lymph nodes, the acquisition rate for fine-needle aspiration cytological biopsy was slightly higher than that for histological biopsy, with values of 95.7% (1374/1435) and 91.4% (1312/1435), respectively. For the thyroid nodule patients, when the acquired histological and cytological biopsy results were compared with the post-surgical etiology results, the sensitivity, specificity, and accuracy of the histological results were 98.5%, 100%, and 98.9%, respectively, whereas those of the cytological results were 86.8%, 82.9%, and 85.6%, respectively; the differences between the 2 biopsy methods were statistically significant (P < 0.05). For the patients with enlarged cervical lymph nodes, when the acquired histological and cytological biopsy results were compared with the post-surgical etiology results, the sensitivity, specificity, and accuracy of the histological results were 96.3%, 99.8%, and 97.6%, respectively, whereas the those of the cytological results were 76.8%, 92.1%, and 82.2%, respectively; again, the differences between the 2 methods were statistically significant (P < 0.05). In conclusion, Fine-needle aspiration histological biopsy is a reliable and highly

  5. Surgical education and training in an outer metropolitan hospital: a qualitative study of surgical trainers and trainees.

    Science.gov (United States)

    Nestel, Debra; Harlim, Jennifer; Bryant, Melanie; Rampersad, Rajay; Hunter-Smith, David; Spychal, Bob

    2016-07-14

    The landscape of surgical training is changing. The anticipated increase in the numbers of surgical trainees and the shift to competency-based surgical training places pressures on an already stretched health service. With these pressures in mind, we explored trainers' and trainees' experiences of surgical training in a less traditional rotation, an outer metropolitan hospital. We considered practice-based learning theories to make meaning of surgical training in this setting, in particular Actor-network theory. We adopted a qualitative approach and purposively sampled surgical trainers and trainees to participate in individual interviews and focus groups respectively. Transcripts were made and thematically analysed. Institutional human research ethics approval was obtained. Four surgical trainers and fourteen trainees participated. Almost without exception, participants' report training needs to be well met. Emergent inter-related themes were: learning as social activity; learning and programmatic factors; learning and physical infrastructure; and, learning and organizational structure. This outer metropolitan hospital is suited to the provision of surgical training with the current rotational system for trainees. The setting offers experiences that enable consolidation of learning providing a rich and varied overall surgical training program. Although relational elements of learning were paramount they occurred within a complex environment. Actor-network theory was used to give meaning to emergent themes acknowledging that actors (both people and objects) and their interactions combine to influence training quality, shifting the focus of responsibility for learning away from individuals to the complex interactions in which they work and learn.

  6. A prospective randomized study comparing 25-G and 22-G needles of a new platform for endoscopic ultrasound-guided fine needle aspiration of solid masses.

    Science.gov (United States)

    Carrara, Silvia; Anderloni, Andrea; Jovani, Manol; Di Tommaso, Luca; Rahal, Daoud; Hassan, Cesare; Ridola, Lorenzo; Federico, Davide; Loriga, Alessandra; Repici, Alessandro

    2016-01-01

    A new needle platform for endoscopic ultrasound-guided fine-needle aspiration biopsy has been developed that allows interchangeability of all needle sizes. To prospectively compare the efficacy of the new 25-G needles and 22-G needles for obtaining an adequate aspirate of solid masses. Randomized controlled trial of 144 patients referred for endoscopic ultrasound-guided fine-needle aspiration of solid pancreatic masses, intraparietal tumours, or lymph-nodes, randomized to the 25-G or 22-G needle arms. An adequate specimen was obtained from 74.3% of cases. The sample tended to be more adequate in the 25-G compared to the 22-G group (81% vs. 68%; p=0.09). Crossover was required in 14 (19%) and 12 (17%) cases in the 22-G and in the 25-G groups, respectively (p=0.7). The overall rate of adequacy improved from 74% before crossover to 90% after crossover (pneedle was superior to the 22-G needle for endoscopic ultrasound-guided fine-needle aspiration biopsy. The adequacy and diagnostic accuracy improved after crossover, reaching 90%. Copyright © 2015 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

  7. Surgical-orthodontic correction of a Class III dentofacial deformity

    Directory of Open Access Journals (Sweden)

    Raghu Devanna

    2010-01-01

    Full Text Available This case report describes the surgical-orthodontic treatment of a 26-year-old post-pubertal male patient with a Class III dentofacial deformity. In the pre-surgical orthodontic phase of treatment, a reverse overjet of 5.5 mm was created and arch compatibility was obtained. A mandibualr set back with BSSO was performed during surgery to restore ideal overjet, overbite, occlusion and optimal esthetics. After 1 year of treatment, the results remained stable.

  8. Surgical-orthodontic correction of a Class III dentofacial deformity

    OpenAIRE

    Raghu Devanna; Neelima Kakkirala

    2010-01-01

    This case report describes the surgical-orthodontic treatment of a 26-year-old post-pubertal male patient with a Class III dentofacial deformity. In the pre-surgical orthodontic phase of treatment, a reverse overjet of 5.5 mm was created and arch compatibility was obtained. A mandibualr set back with BSSO was performed during surgery to restore ideal overjet, overbite, occlusion and optimal esthetics. After 1 year of treatment, the results remained stable.

  9. Successful Percutaneous Coronary Intervention through a Severely Bent Artificial Ascending Aorta Using the DIO Thrombus Aspiration Catheter

    Directory of Open Access Journals (Sweden)

    Akinori Fujikake

    2016-01-01

    Full Text Available A 66-year-old man was admitted to our institute because of chest pain. He had undergone replacement of the ascending aorta due to aortic dissection 9 years previously. We made a diagnosis of acute coronary syndrome, and coronary artery angiography was performed. Although the right coronary artery was successfully cannulated, a severe bend of the artificial aorta made it very difficult to advance the catheter into the left coronary artery. Ultimately, a DIO thrombus aspiration catheter was used to enter the left coronary artery, and a stent was implanted successfully. The DIO catheter is very useful when the selection of a guiding catheter is complicated, such as in the case of severe vessel tortuosity or a bend of the ascending aorta.

  10. Paediatric surgical abdominal emergencies in a north central ...

    African Journals Online (AJOL)

    pain/distension and/or vomiting as chief complaint. Fourteen (63.7%) ... This prospective study was carried out at a tertiary public healthcare centre ..... Retrospective study of visceral surgical emergencies in children at the University. Hospital ...

  11. A projective surgical navigation system for cancer resection

    Science.gov (United States)

    Gan, Qi; Shao, Pengfei; Wang, Dong; Ye, Jian; Zhang, Zeshu; Wang, Xinrui; Xu, Ronald

    2016-03-01

    Near infrared (NIR) fluorescence imaging technique can provide precise and real-time information about tumor location during a cancer resection surgery. However, many intraoperative fluorescence imaging systems are based on wearable devices or stand-alone displays, leading to distraction of the surgeons and suboptimal outcome. To overcome these limitations, we design a projective fluorescence imaging system for surgical navigation. The system consists of a LED excitation light source, a monochromatic CCD camera, a host computer, a mini projector and a CMOS camera. A software program is written by C++ to call OpenCV functions for calibrating and correcting fluorescence images captured by the CCD camera upon excitation illumination of the LED source. The images are projected back to the surgical field by the mini projector. Imaging performance of this projective navigation system is characterized in a tumor simulating phantom. Image-guided surgical resection is demonstrated in an ex-vivo chicken tissue model. In all the experiments, the projected images by the projector match well with the locations of fluorescence emission. Our experimental results indicate that the proposed projective navigation system can be a powerful tool for pre-operative surgical planning, intraoperative surgical guidance, and postoperative assessment of surgical outcome. We have integrated the optoelectronic elements into a compact and miniaturized system in preparation for further clinical validation.

  12. Ultrasound-guided fine needle aspiration cytology as an addendum to sentinel lymph node biopsy can perfect the staging strategy in melanoma patients

    NARCIS (Netherlands)

    C. Voit (Christiane); S.L.M. Gooskens (Saskia); P. Siegel (Petra); G. Schaefer (Gregor); A. Schöngen (Alfred); J. Röwert (Joachim); A.C.J. van Akkooi (Alexander); A.M.M. Eggermont (Alexander)

    2014-01-01

    textabstractBackground Ultrasound guided fine needle aspiration cytology (US-guided FNAC) can identify microscopic involvement of lymph nodes as in breast cancer and avoid surgical sentinel node (SN). Its utility in melanoma patients is controversial and subject of this study. Methods Between 2001 a

  13. A rare case of myxoid liposarcoma of the adult foot diagnosed using fine needle aspiration cytology (FNAC

    Directory of Open Access Journals (Sweden)

    Kure S

    2014-12-01

    Full Text Available Shoko Kure,1 Wei-Xia Peng,1 Mitsuhiro Kudo,1 Miyuki Matsubara,2 Takashi Tsunoda,3 Zenya Naito1,21Department of Integrated Diagnostic Pathology, Nippon Medical School, 2Department of Pathology, Nippon Medical School Hospital, 3Department of Orthopedics, Nippon Medical School Department of Orthopedics, Nippon Medical School, Tokyo, JapanAbstract: Liposarcoma is categorized as a soft tissue sarcoma that most commonly appears in the lower extremities during adulthood, but rarely in the feet. We present a rare case of a primary myxoid liposarcoma in the foot of a 63-year-old man that was diagnosed by fine needle aspiration cytology (FNAC. The patient presented to our hospital with a 10-year history of a slow-growing mass on the left lateral ankle. On physical examination, the 60 mm ×60 mm mass, was found to be soft and elastic, causing poor mobility without pain. Magnetic resonance imaging of the mass revealed high signal intensity on T1-weighted images and heterogeneously high signal intensity on T2-weighted images without fat suppression. As a result of the physical examination and imaging, the mass was suspected to be a lipoma or ganglion cyst. However, the FNAC procedure revealed atypical small, round, short spindle cells, or foamy cells with a myxoid background, suggesting myxoid liposarcoma. Histology using an open biopsy showed a proliferation of atypical spindle and asteroid cells with a few foamy lipoblasts in a capillary-rich and myxoid background. The atypical lipoblasts were slightly positive for S-100. These findings were consistent with myxoid liposarcoma. The patient was treated with a resection of the mass. Liposarcoma is considered to be the second most common soft-tissue sarcoma. It usually involves the lower extremities, particularly the thigh, and is very rare in the adult foot. Our case was a rare occurrence of myxoid liposarcoma of the foot diagnosed preoperatively using FNAC.Keywords: myxoid liposarcoma, foot, fine needle

  14. Surgical training in your hands: organising a skills course.

    Science.gov (United States)

    Burnand, Henry; Mutimer, Jon

    2012-12-01

    The advent of simulated surgical skills courses has brought dynamic changes to the traditional approach to acquiring practical skills in surgery. Teaching is a core part of the surgical profession, and any trainee can be involved in the organisation of skills training courses. This paper outlines the importance of organising surgical skills courses for trainees, and provides a practical guide on how to do so within busy clinical environments. The paper examines how to plan a course, how to design the programme, and provides tips on faculty staff requirements, venue, finance and participants, with additional suggestions for assessment and evaluation. We recommend the organisation of skills courses to any trainee. By following key ground rules, the surgical trainee can enable the acquisition of advanced learning opportunities and the ability to demonstrate valuable organisational skills. © Blackwell Publishing Ltd 2012.

  15. Managing a surgical unit using google drive - a feasibility study

    Directory of Open Access Journals (Sweden)

    Ashley Solomon C.

    2016-10-01

    Conclusions: It is feasible to use google drive as a patient management system by a surgical unit to organise work. This system is efficient, secure and cost effective. [Int J Res Med Sci 2016; 4(10.000: 4365-4369

  16. Bone Marrow Aspiration and Biopsy

    Science.gov (United States)

    ... Advertising & Sponsorship: Policy | Opportunities Bone Marrow Aspiration and Biopsy Share this page: Was this page helpful? Also ... Examination Formal name: Bone Marrow Aspiration; Bone Marrow Biopsy Related tests: Complete Blood Count ; WBC Differential ; Reticulocyte ...

  17. Identification of second malignancies on effusions and fine-needle aspirates using a panel of monoclonal antibodies.

    Science.gov (United States)

    Mottolese, M.; Venturo, I.; Rinaldi, M.; Lopez, M.; Bigotti, G.; Benevolo, M.; Natali, P. G.

    1997-01-01

    The longer survival of neoplastic patients achieved through improvements of therapeutic regimens has increased the relative risk of developing a second primary tumour (SPT). In this context, conventional cytopathology can define tumour histotype only in a small fraction of cases. In this study, we have evaluated whether selected combinations of monoclonal antibodies (MAbs) to tumour-associated antigens (TAAs) can increase the accuracy of conventional morphology in detecting second primary tumours (SPTs) in two particularly difficult areas of cytodiagnosis, namely that of effusions and pulmonary fine-needle aspirates (FNAs). The immunocytochemical (ICC) analysis of 334 cytological specimens demonstrated that the use of our selected panel of MAbs could allow a more efficient identification of SPTs in comparison with conventional morphology. This diagnostic improvement was statistically significant (P < 0.0001). The present findings show that the immunophenotyping of effusions and FNAs, providing a more accurate and objective identification of SPTs, may have significant therapeutic and epidemiological relevance. PMID:9052413

  18. Fine-needle aspiration detects primary neuroendocrine carcinoma of the breast in a patient with breast implants

    Directory of Open Access Journals (Sweden)

    Janet I Malowany

    2015-01-01

    Full Text Available Breast augmentation with implantation represents a challenge for subsequent radiographic imaging and pathological sampling. Fine-needle aspiration biopsy (FNAB is an excellent technique to sample suspicious lesions that are adjacent to fragile implants. We report a case of a 51-year-old woman with breast implants presenting with an initial diagnosis of fibroadenoma by imaging studies. A definite diagnosis of mammary carcinoma with plasmacytoid cells was made on ultrasound (US-guided FNAB of the breast mass with rapid on-site evaluation which initiated core needle biopsy of the mass and subsequent mastectomy with sentinel lymph node biopsy. Our case exemplifies the role of US-guided FNAB for the initial investigation of breast masses in patients with implants. In addition, the case illustrates the cytomorphological features of the tumor cells in primary neuroendocrine carcinoma of the breast.

  19. Orthodontic Wire Ingestion during Treatment: Reporting a Case and Review the Management of Foreign Body Ingestion or Aspiration (Emergencies

    Directory of Open Access Journals (Sweden)

    Mohammad Hoseini

    2013-01-01

    Full Text Available Today orthodontic treatment is in growing demand and is not limited to a specific age or social group. The nature of orthodontic treatment is such that the orthodontic wires and appliances, which are used to apply force and move the teeth, are exposed to the oral cavity. Shaping and replacing these wires in oral cavity are the major assignments of orthodontist on appointments. Therefore, we can say that orthodontic treatment requires working with dangerous tools in a sensitive place like oral cavity which is the entrance of respiratory and digestive systems. In this paper, a case of ingesting a broken orthodontic wire during eating is reported, and also necessary remedial measures at the time of encountering foreign body ingestion or aspiration are provided.

  20. Orthodontic Wire Ingestion during Treatment: Reporting a Case and Review the Management of Foreign Body Ingestion or Aspiration (Emergencies).

    Science.gov (United States)

    Hoseini, Mohammad; Mostafavi, Seyed Morteza Saadat; Rezaei, Navid; Boluri, Ehsan Javadzadeh

    2013-01-01

    Today orthodontic treatment is in growing demand and is not limited to a specific age or social group. The nature of orthodontic treatment is such that the orthodontic wires and appliances, which are used to apply force and move the teeth, are exposed to the oral cavity. Shaping and replacing these wires in oral cavity are the major assignments of orthodontist on appointments. Therefore, we can say that orthodontic treatment requires working with dangerous tools in a sensitive place like oral cavity which is the entrance of respiratory and digestive systems. In this paper, a case of ingesting a broken orthodontic wire during eating is reported, and also necessary remedial measures at the time of encountering foreign body ingestion or aspiration are provided.

  1. Bilaterally enlarged parotids and sicca symptoms as a presentation of sarcoidosis: Pivotal role of aspiration cytology in diagnosis

    Directory of Open Access Journals (Sweden)

    Tanya Sharma

    2015-01-01

    Full Text Available Sarcoidosis is a chronic multisystem inflammatory disease of unknown etiology characterized by widespread noncaseating granulomas in various organs. The diagnosis of sarcoidosis is based on cytological, clinicolaboratory, and radiological findings, and requires careful exclusion of other granulomatous diseases especially tuberculosis. Involvement of parotid glands is uncommon. Presentation of sarcoidosis with sicca symptoms that include dryness of eyes and mouth is an even rarer phenomenon. We present a case of multisystemic sarcoidosis presenting with dryness of eyes and mouth along with bilateral enlargement of parotid glands. Fine-needle aspiration cytology (FNAC smears showed epithelioid cell granulomas and multinucleate giant cells. Stain for acid-fast bacilli was negative. Careful cytological examination revealed crystalline structures inside the giant cells, which prompted us to evaluate the patient for sarcoidosis. This case report highlights the cytological features that can be useful in clinching the diagnosis of sarcoidosis in conjunction with clinicoradiological and laboratory findings in a clinically unusual case.

  2. Methods specification for diagnostic test accuracy studies in fine-needle aspiration cytology: a survey of reporting practice.

    Science.gov (United States)

    Schmidt, Robert L; Factor, Rachel E; Affolter, Kajsa E; Cook, Joshua B; Hall, Brian J; Narra, Krishna K; Witt, Benjamin L; Wilson, Andrew R; Layfield, Lester J

    2012-01-01

    Diagnostic test accuracy (DTA) studies on fine-needle aspiration cytology (FNAC) often show considerable variability in diagnostic accuracy between study centers. Many factors affect the accuracy of FNAC. A complete description of the testing parameters would help make valid comparisons between studies and determine causes of performance variation. We investigated the manner in which test conditions are specified in FNAC DTA studies to determine which parameters are most commonly specified and the frequency with which they are specified and to see whether there is significant variability in reporting practice. We identified 17 frequently reported test parameters and found significant variation in the reporting of these test specifications across studies. On average, studies reported 5 of the 17 items that would be required to specify the test conditions completely. A more complete and standardized reporting of methods, perhaps by means of a checklist, would improve the interpretation of FNAC DTA studies.

  3. Use of fine needle aspiration cytology in the diagnosis of cutaneous leishmaniasis: a comparison with the conventional scraping method.

    Science.gov (United States)

    Hosseinzadeh, Massood; Omidifar, Navid; Lohrasb, Mohamad Hosein

    2012-04-01

    Cutaneous leishmaniasis is endemic in Iran. Scraping smears are widely used and fine needle aspiration (FNA) cytology is now attracting more attention. Both methods were performed on the clinically suspected cases in our study. Smears were stained using Giemsa. We compared the sensitivity, specificity and some other aspects of these two methods. Of our 400 patients, 346 had specimens that were positive for leishman body, and of these 328 were detected using both methods. However, 42 cases were confirmed positive by FNA cytology and 18 as a result of scraping smears. There was a significant difference between the two methods in the detection of leishman body and microgranuloma, slide background and patient comfort. The sensitivity of FNA cytology was greater even though the specificity was the same. Our study confirmed the advantages of FNA cytology as a reliable method for the diagnosis of cutaneous leishmaniasis.

  4. Aspirated High Pressure Compressor

    Science.gov (United States)

    2006-08-01

    of Technology Aamir Shabbir Cambridge, Massachusetts 02139, USA University of Toledo Toledo , Ohio 43606, USA ABSTRACT transport engine aspirated...special thanks to Jack Costa, James Letendre, and Victor Dubrowski for their tireless work in the lab. The instruments were partially the result of

  5. Neuroendoscopic Resection of Intraventricular Tumors and Cysts through a Working Channel with a Variable Aspiration Tissue Resector: A Feasibility and Safety Study

    Directory of Open Access Journals (Sweden)

    Edjah Kweku-Ebura Nduom

    2013-01-01

    Full Text Available Pure neuroendoscopic resection of intraventricular lesions through a burr hole is limited by the instrumentation that can be used with a working channel endoscope. We describe a safety and feasibility study of a variable aspiration tissue resector, for the resection of a variety of intraventricular lesions. Our initial experience using the variable aspiration tissue resector involved 16 patients with a variety of intraventricular tumors or cysts. Nine patients (56% presented with obstructive hydrocephalus. Patient ages ranged from 20 to 88 years (mean 44.2. All patients were operated on through a frontal burr hole, using a working channel endoscope. A total of 4 tumors were resected in a gross total fashion and the remaining intraventricular lesions were subtotally resected. Fifteen of 16 patients had relief of their preoperative symptoms. The 9 patients who presented with obstructive hydrocephalus had restoration of cerebrospinal fluid flow though one required a ventriculoperitoneal shunt. Three patients required repeat endoscopic resections. Use of a variable aspiration tissue resector provides the ability to resect a variety of intraventricular lesions in a safe, controlled manner through a working channel endoscope. Larger intraventricular tumors continue to pose a challenge for complete removal of intraventricular lesions.

  6. A SURGICAL SURPRISE: A RARE CASE REPORT

    Directory of Open Access Journals (Sweden)

    Jaya Shree

    2014-08-01

    Full Text Available Implantation of the blastocyst anywhere else other than the uterine cavity is ectopic pregnancy. Ovarian Pregnancy is one of the rare forms of an ectopic pregnancy. The incidence of ovarian pregnancy is 0.15 to 3 % 1 of all ectopic pregnancies. Here we present a case of ruptured ovarian pregnancy, which was preoperatively diagnosed as ruptured tubal pregnancy and later found to be an ovarian pregnancy at laparotomy.

  7. Surgical robotics: the early chronicles: a personal historical perspective.

    Science.gov (United States)

    Satava, Richard M

    2002-02-01

    The use of robotics has been emerging for approximately 75 years, but only during the past 5 years has the potential of robotics been recognized by the surgical community as a whole. This personal perspective chronicles the development of robotics for the general surgical community, the role of the military medical research effort, and many of the major programs that contributed to the current success of robotics.

  8. Surgical crown lengthening: a periodontal and restorative interdisciplinary approach.

    Science.gov (United States)

    Parwani, Simran R; Parwani, Rajkumar N

    2014-01-01

    Surgical crown lengthening helps to provide an adequate retention form for proper tooth preparation, thus enabling dentists to create esthetically pleasing and healthy restorations. Long-term stability requires accurate diagnosis and development of a comprehensive treatment plan in each case. This sequence of events stresses the importance of communication between the restorative dentist and the periodontist. This article presents 2 cases that involve surgical crown lengthening (including mucoperiosteal flap and ostectomy) for the restoration of teeth.

  9. Three different surgical techniques of crown lengthening: A comparative study

    OpenAIRE

    Ramya Nethravathy; Santhana Krishnan Vinoth; Ashwin Varghese Thomas

    2013-01-01

    Introduction: A short clinical crown may lead to poor retention form thereby leading to improper tooth preparation. Surgical crown lengthening procedure is done to increase the clinical crown length without violating the biologic width. Several techniques have been proposed for clinical crown lengthening which includes gingivectomy, apically displaced flap with or without resective osseous surgery, and surgical extrusion using periotome. Objective: The aim of this paper is to compare clinical...

  10. Rapid quantification of Staphylococcus aureus from endotracheal aspirates of ventilated patients: a proof-of-concept study.

    Science.gov (United States)

    Lacroix, Morgane; Barraud, Olivier; Clavel, Marc; Filiputti, Delphine; Prudent, Sandrine; François, Bruno; Ploy, Marie Cécile; Jestin, Marie-Astrid; Rodrigue, Marc; Pachot, Alexandre; Yugueros-Marcos, Javier; Moucadel, Virginie

    2015-10-01

    Major concern for intubated patients is ventilator-associated pneumonia (VAP). Early detection of VAP and its causative microorganism(s) is a key challenge for clinicians. Diagnosis is based on clinical, radiological, and microbiological elements, the latter being provided 24-48h after sampling. According to practices, clinicians can sample endotracheal aspirates (ETAs) so as to check for patient colonization or perform ETA in case of VAP suspicion. In this proof-of-concept study, we report the evaluation of a semiautomated molecular method to rapidly quantify Staphylococcus aureus, one of the most involved microorganisms in VAP, directly from raw ETA samples. After evaluation using artificial ETA samples, our method was applied on 40 clinical ETA samples. All S. aureus-positive samples were successfully detected and quantified. Our method can provide an efficient sample preparation protocol for all raw ETA samples, combined with an accurate quantification of the bacterial load, in less than 3h 30min.

  11. Fine-needle aspiration and core biopsy in the diagnosis of breast lesions: A comparison and review of the literature

    Science.gov (United States)

    Mitra, Suvradeep; Dey, Pranab

    2016-01-01

    In recent times, the diagnosis of breast lesions has mostly become dependent on core needle biopsies (CNBs) with a gradual reduction in the rate of performing fine-needle aspiration cytology (FNAC). Both the procedures have their pros and cons and outsmart each other taking into account different parameters. Both the methods are found to be fraught with loopholes, taking into account different performance indices, diagnostic accuracy and concordance, patient benefit, and cost-effectiveness. Unlike the popular belief of an absolute superiority of CNB over FNAC, the literature review does not reveal a very distinct demarcation in many aspects. We recommend judicious use of these diagnostic modalities in resource-limited settings and screening programs taking into account parameters such as palpability and availability of an experienced cytopathologist. PMID:27651820

  12. Three different surgical techniques of crown lengthening: A comparative study

    Directory of Open Access Journals (Sweden)

    Ramya Nethravathy

    2013-01-01

    Full Text Available Introduction: A short clinical crown may lead to poor retention form thereby leading to improper tooth preparation. Surgical crown lengthening procedure is done to increase the clinical crown length without violating the biologic width. Several techniques have been proposed for clinical crown lengthening which includes gingivectomy, apically displaced flap with or without resective osseous surgery, and surgical extrusion using periotome. Objective: The aim of this paper is to compare clinically the three different surgical techniques of crown lengthening procedures. Materials and Methods: Fifteen patients who reported to the department of Periodontology, were included in the study. Patients were randomly divided into three groups, which include patients who underwent gingivectomy (Group A, apically repositioned flap (Group B and surgical extrusion using periotome (Group C. Clinical measurements such as clinical crown length, gingival zenith, interdental papilla height were taken at baseline and at 3 rd month post-operatively. Results: Clinical and radiographic evaluation at 3 rd month suggest that surgical extrusion technique offers several advantages over the other conventional surgical techniques such as preservation of the interproximal papilla, gingival margin position and no marginal bone loss. Conclusions: This technique can be used to successfully treat a grossly damaged crown structure as a result of tooth fracture, dental caries and iatrogenic factors especially in the anterior region, where esthetics is of great concern.

  13. Assessment of molecular testing in fine-needle aspiration biopsy samples: an experience in a Chinese population.

    Science.gov (United States)

    Liu, Shu; Gao, Aibo; Zhang, Bingfei; Zhang, Zhaoxia; Zhao, Yanru; Chen, Pu; Ji, Meiju; Hou, Peng; Shi, Bingyin

    2014-10-01

    Fine-needle aspiration biopsy remains the mainstay for preoperative examination of thyroid nodules; however, it does not provide a definite diagnosis in up to 25% of nodules. Considerable studies have been performed to identify molecular markers to resolve this diagnostic dilemma. The aim of this study was to establish the distribution and frequency of common genetic alterations in a comprehensive set of benign and malignant thyroid nodules, and to determine the feasibility and role of testing for a panel of genetic alterations in improving the accuracy of cytology diagnosis in a Chinese population. This study was conducted in 314 thyroid nodules comprising 104 papillary thyroid carcinomas, 13 suspicious nodules, 52 indeterminate nodules, and 145 benign nodules. Point mutations and RET/PTC rearrangements, were evaluated by pyrosequencing and TaqMan real-time PCR, respectively. After surgery, 115 nodules were confirmed as conventional papillary thyroid carcinoma and 102 (88.70%) of these nodules harbored either the BRAF(V600E) mutation (76.52%) or RET/PTC rearrangements (12.17%). RAS mutation was found in 1 (33.33%) follicular thyroid carcinoma, 1 (14.29%) follicular thyroid adenoma and 4 (10%) goiter nodules. With cytology and molecular testing, the diagnostic accuracy was further increased to 98.82% in papillary thyroid carcinoma diagnosis, and was preoperatively increased to 76.92% and 84.00%, respectively, in nodules with suspicious and indeterminate cytology. In conclusion, molecular testing of a panel of genetic alterations in fine-needle aspiration biopsy can be effectively performed in clinical practice. It enhances the accuracy of cytology and is of particular value for indeterminate nodules in the Chinese population. Copyright © 2014 Elsevier Inc. All rights reserved.

  14. A review of the surgical approaches to glaucoma treatment

    Directory of Open Access Journals (Sweden)

    Spratt Alexander

    2013-07-01

    Full Text Available The conventional approach of initially treating glaucoma medically and holding surgical intervention as a reserve option was endorsed by the findings of the Collaborative Initial Glaucoma Treatment Study (CIGTS study.1 This study reported that patients had similar visual field outcomes at five years from either medical treatment or immediate filtration surgery and supported the status quo of glaucoma management. The market for medical treatments has since increased and polypharmacy is now an accepted norm for glaucoma treatment. Surgical remedies for glaucoma have existed in a less pressured environment such that trabeculectomy, after four decades of slow evolution and complications, remains the most commonly performed type of glaucoma surgery worldwide. This ecosystem has begun to change in recent years. New surgical alternatives have arrived, reached a sizeable number and gained considerable traction as viable competitors to conventional glaucoma medical and surgical treatments. This raises important questions as to how these advances in glaucoma surgical options may affect the future landscape of glaucoma treatment. Has trabeculectomy already yielded some of its high ground? Why has trabeculectomy not been able to evolve more rapidly in response to new competitive pressures? If trabeculectomy has reached its evolutionary zenith are the newer alternatives any better? And, is it time to re-examine the conventional ‘medical before surgical’ approach to glaucoma? This article reviews the evidence for current surgical techniques available to patients with glaucoma.

  15. Endoscopic Ultrasound-Guided Fine-Needle Aspiration of Pancreatic Lesions: A Systematic Review of Technical and Procedural Variables.

    Science.gov (United States)

    Jani, Bhairvi S; Rzouq, Fadi; Saligram, Shreyas; Lim, Diego; Rastogi, Amit; Bonino, John; Olyaee, Mojtaba

    2016-01-01

    Endoscopic ultrasound (EUS)-guided tissue acquisition has emerged over the last decade as an invaluable diagnostic tool in approaching the different pancreatic lesions. Given the safety and minimal invasiveness of this approach combined with the high diagnostic yield, it became the standard of care when dealing with different pancreatic pathologies. However, some variables regarding this procedure remain not fully understood. These can influence the diagnostic yield of the procedure and include the presence of the on-site cytopathologist, the type and size of the needle used as well as obtaining aspiration versus core biopsy, the number of passes and the sampling technique, and the role of suction and stylet use among others. We performed a comprehensive literature search using PubMed, Google Scholar, and Embase for studies that assessed these variables. Eligible studies were analyzed using several parameters such as technique and procedure, with the aim of reviewing results from an evidence-based standpoint.

  16. Endoscopic ultrasound-guided fine-needle aspiration of pancreatic lesions: A systematic review of technical and procedural variables

    Directory of Open Access Journals (Sweden)

    Bhairvi S Jani

    2016-01-01

    Full Text Available Endoscopic ultrasound (EUS-guided tissue acquisition has emerged over the last decade as an invaluable diagnostic tool in approaching the different pancreatic lesions. Given the safety and minimal invasiveness of this approach combined with the high diagnostic yield, it became the standard of care when dealing with different pancreatic pathologies. However, some variables regarding this procedure remain not fully understood. These can influence the diagnostic yield of the procedure and include the presence of the on-site cytopathologist, the type and size of the needle used as well as obtaining aspiration versus core biopsy, the number of passes and the sampling technique, and the role of suction and stylet use among others. We performed a comprehensive literature search using PubMed, Google Scholar, and Embase for studies that assessed these variables. Eligible studies were analyzed using several parameters such as technique and procedure, with the aim of reviewing results from an evidence-based standpoint.

  17. Endoscopic Ultrasound-Guided Fine-Needle Aspiration of Pancreatic Lesions: A Systematic Review of Technical and Procedural Variables

    Science.gov (United States)

    Jani, Bhairvi S.; Rzouq, Fadi; Saligram, Shreyas; Lim, Diego; Rastogi, Amit; Bonino, John; Olyaee, Mojtaba

    2016-01-01

    Endoscopic ultrasound (EUS)-guided tissue acquisition has emerged over the last decade as an invaluable diagnostic tool in approaching the different pancreatic lesions. Given the safety and minimal invasiveness of this approach combined with the high diagnostic yield, it became the standard of care when dealing with different pancreatic pathologies. However, some variables regarding this procedure remain not fully understood. These can influence the diagnostic yield of the procedure and include the presence of the on-site cytopathologist, the type and size of the needle used as well as obtaining aspiration versus core biopsy, the number of passes and the sampling technique, and the role of suction and stylet use among others. We performed a comprehensive literature search using PubMed, Google Scholar, and Embase for studies that assessed these variables. Eligible studies were analyzed using several parameters such as technique and procedure, with the aim of reviewing results from an evidence-based standpoint. PMID:27011940

  18. Yield of new versus reused endobronchial ultrasound-guided transbronchial needle aspiration needles: A retrospective analysis of 500 patients

    Directory of Open Access Journals (Sweden)

    Sahajal Dhooria

    2016-01-01

    Full Text Available Background: Endobronchial ultrasound (EBUS-guided transbronchial needle aspiration (TBNA requires a dedicated needle for aspiration of mediastinal lesions. There is no data on reuse of these needles. Methods: This is a retrospective study of patients who underwent EBUS-TBNA with either new or reused EBUS-TBNA needles. The needles were reused after thorough cleaning with filtered water and organic cleaning solution, disinfection with 2.4% glutaraldehyde solution followed by ethylene oxide sterilization. The yield of EBUS-TBNA was compared between the two groups. Results: A total of 500 EBUS-TBNA procedures (351 new, 149 reused needles were performed. The baseline characteristics were different in the two groups with suspected granulomatous disorders (sarcoidosis or tuberculosis being significantly more common in the new compared to the reused needle group. Similarly, the median, interquartile range number of lymph node stations sampled, and the total number of passes were significantly higher in the new versus the reused needle group. The diagnostic yield was significantly higher with new needle as compared to reused needle (65.2% vs. 53.7%, P = 0.02. On multivariate logistic regression analysis, clinical suspicion of granulomatous disorders (odds ratio 1.86 [95% confidence interval, 1.20-2.87], P = 0.005 was the only predictor of diagnostic yield, after adjusting for the type of needle (new or reused, total number of passes and the number of lymph node stations sampled. No case of mediastinitis was encountered in either group. Conclusions: The yield of EBUS-TBNA might be similar with single reuse of needles as compared to new needles. However, reuse of needle should be performed only when absolutely necessary.

  19. Service Quality Of Diagnostic Fine Needle Aspiration Cytology In A Tertiary Care Hospital Of Lahore (Process Measure As Patient's Perspective).

    Science.gov (United States)

    Rizvi, Zainab; Usmani, Rabia Arshed; Rizvi, Amna; Wazir, Salim; Zahra, Taskeen; Rasool, Hafza

    2017-01-01

    Quality of any service is the most important aspect for the manufacturer as well as the consumer. The primary objective of any nation's health system is to provide supreme quality health care services to its patients. The objective of this study was to assess the quality of diagnostic fine needle aspiration cytology service in a tertiary care hospital. As Patient's perspectives provide valuable information on quality of process, therefore, patient's perception in terms of satisfaction with the service was measured. In this cross sectional analytical study, 291 patients undergoing fine needle aspiration cytology in Mayo Hospital were selected by systematic sampling technique. Information regarding satisfaction of patients with four dimensions of service quality process, namely "procedure, sterilization, conduct and competency of doctor" was collected through interview on questionnaire. The questionnaire was developed on SERVQUAL model, a measurement tool, for quality assessment of services provided to patients. All items were assessed on 2- point likert scale (0=dissatisfied, 1=satisfied). Frequencies and percentages of satisfied and dissatisfied patients were recorded for each item and all items in each dimension were scored. If the percentage of sum of all item scores of a dimension was ≥60, the dimension was 'good quality'. Whereas quality' dimension. Data was analysed using epi-info-3.5.1. Fisher test was applied to check statistical significance. (p-value service quality process, Procedure (48.8%), Sterilization (51.5%) and practitioner conduct (50.9%) were perceived as 'poor' by the patients. Only practitioner competency (67.4%) was perceived as 'good'. Comparison of dimensions of service quality scoring with overall level of patient satisfaction revealed that all 4 dimensions were significantly related to patient dissatisfaction (pservice quality of therapeutic and diagnostic procedures in public hospitals should be routinely monitored from the patients

  20. Ingested and Aspirated Foreign Bodies.

    Science.gov (United States)

    Green, S Sarah

    2015-10-01

    Esophageal and aspirated foreign bodies have important clinical significance, and both should be considered carefully when the history or physical examination findings raise sufficient suspicion. The published evidence regarding the diagnosis and management of foreign body ingestion or aspiration is weighted disproportionately with observational studies, case controls, expert opinion, and systematic reviews. Most of the publications would receive a categorization of C (observational studies including case-control and cohort design) and D (expert opinion, case reports, and clinical reasoning). One of the few prospective studies examining the diagnostic evaluation of foreign body aspiration in children could be considered level B evidence (randomized clinical trials, systematic reviews, or diagnostic studies with minor limitations). This study found that the medical history is the most important predictive part of the evaluation. There is evidence for considering bronchoscopy if there is significant history suggestive of foreign body aspiration, even in the setting of normal physical examination findings. (28). Most ingested foreign bodies spontaneously pass without incident. However, special attention should be paid to objects in the esophagus as well as to batteries and magnets. Based on a systematic review of the literature (level B evidence) and the potential for rapid and life-threatening damage, batteries in the esophagus should be removed immediately. (10) Other objects, such as coins, may be observed for passage in an asymptomatic patient. In addition, given the high risk of significant complications, ingestion of high-powered magnets should be quickly and carefully evaluated. Although single magnets are likely to pass without complication, multiple magnets or magnets ingested with other metal objects can cause significant damage and should be removed if there is any concern for mural entrapment, bowel perforation, or failure to progress. (10

  1. A Targeted E-Learning Program for Surgical Trainees to Enhance Patient Safety in Preventing Surgical Infection

    Science.gov (United States)

    McHugh, Seamus Mark; Corrigan, Mark; Dimitrov, Borislav; Cowman, Seamus; Tierney, Sean; Humphreys, Hilary; Hill, Arnold

    2010-01-01

    Introduction: Surgical site infection accounts for 20% of all health care-associated infections (HCAIs); however, a program incorporating the education of surgeons has yet to be established across the specialty. Methods: An audit of surgical practice in infection prevention was carried out in Beaumont Hospital from July to November 2009. An…

  2. Topological Studies of Three-dimensional Flows in a High Pressure Compressor Stator Blade Row without and with Boundary Layer Aspiration

    Institute of Scientific and Technical Information of China (English)

    Ankit SACHDEVA; Francis LEBOEUF

    2011-01-01

    This paper presents a numerical study of the flow topologies of three-dimensional(3D)flows in a high pressure compressor stator blade row without and with boundary layer aspiration on the hub wall.The stator blade is representative of the first stage operating under transonic inlet conditions and the blade design encourages development of highly complex 3D flows.The blade has a small tip clearance.The computational fluid dynamics(CFD)studies show progressive increase of hub comer stall with the increase in incidence.Aspiration is implemented on the hub wall via a slot in the comer between the hub wall and the suction surface.The CFD studies show aspiration to be sensitive to the suction flow rate; lower rate leads to very complex flow structures and increased level of losses whereas higher rate renders aspiration effective for control of hub comer separation.The flow topologies are studied by trace of skin friction lines on the walls.The nature of flow can be explained by the topological rules of closed separation.Furthermore,a deeper analysis is done for a particular case with advanced criterion to test the non-degeneracy of critical points in the flow field.

  3. “I can’t fall behind!” Aspirations, Technology and Becoming a Teacher in South Africa

    National Research Council Canada - National Science Library

    Moira Bladergroen; Andy Bytheway; Lorenzo Cantoni; Wallace Chigona; Marta Pucciarelli; Amalia Georgiana Sabiescu

    2014-01-01

    .... The paper examines the aspirations for professional development of undergraduate pre-service teachers in South Africa, and the extent to which these are marked by or influence the formation of technology attitudes...

  4. Effect of Distraction Technique and Hypnosis in Pain of Bone Marrow Aspiration in Children: a Narrative Review

    Directory of Open Access Journals (Sweden)

    Alimorad Heidari Gorji

    2017-03-01

    Full Text Available BackgroundThe present review study provides specific evidence to assess the impact of distraction techniques and hypnosis on the pain of bone marrow aspiration in children.Materials and MethodsThis review study aimed to determine the effects of distraction techniques and hypnosis on the controlling pain of bone marrow aspiration in children. Internal databases (SID, Magiran, IranMedex and Irandoc, and international databases (Google-Scholar, Medline, PubMed, Elsevier, ProQuest, Springer and Web of Science, were searched by using the Mesh key words including "cancer", "bone marrow", "aspiration", "distraction", "hypnosis", "pain", "children" and "pediatric", with no time limit since the foundation of these databases until December 2016.ResultsIn overall review of the articles, based on the issues expressed, the effect of most of various distraction interventions and hypnosis on the pain severity of children under the bone marrow aspiration procedure was significant and positive (P

  5. A descriptive study of variables associated with obtaining nipple aspirate fluid in a cohort of non-lactating women

    Directory of Open Access Journals (Sweden)

    Wrensch Margaret

    2006-10-01

    Full Text Available Abstract Background The search for biologic endpoints and biomarkers in the study of breast cancer risk assessment and risk reduction strategies has led to an interest in obtaining cytologic information and other biomarkers from nipple aspirate fluid (NAF. Methods This descriptive study examined factors associated with an increased ability to obtain NAF in a cohort of 3043 women between the ages of 15 and 89 years of age. The majority of women were between the ages of 30–49 (N = 1529/50.2%. Variables examined in relation to obtaining fluid include: age, marital status, age at menarche, menopausal status, a history of pregnancy, a history of breast-feeding, estrogen use, oral contraceptive use, endocrine disorders and tranquilizer use. Results On average, women from whom breast fluid was obtained were younger than women from whom breast fluid was attempted but not obtained (mean = 41.9 years versus 46.5 years, p Conclusion Four variables (being married, history of pregnancy, tranquilizer use and endocrine disorders remained positively associated with the ability to obtain NAF in all analyses. A younger age was consistently associated with a greater ability to obtain NAF in this and other studies.

  6. Global Surgical Ecosystems: A Need for Systems Strengthening.

    Science.gov (United States)

    deVries, Catherine R; Rosenberg, Jenna S

    As surgery is gaining recognition as a critical component of universal health care worldwide, surgical communities have come together with unprecedented unity to advocate for systems to support surgical care. This community has long believed that much care could be performed in a cost-effective manner even in low resource settings, despite skepticism voiced by many in public health. To do so will require the development of new systems and re-vamping of old systems that are not effective. In the last five years, coalitions, expert panels, commissions, consortia and alliances have emerged to address these issues and there has been landmark success in advocacy with a new resolution at the 2015 World Health Assembly to include surgical care as a component of universal health coverage. It is critical to understand the ecosystem that constitutes the surgical environment. A surgical ecosystem could be described as a network of people, processes, and materials necessary for surgical services in the context of the facilities and environment in which it functions. We describe components of a functioning surgical ecosystem in terms of administration, support staff and clinicians, and the necessary sub-systems for providing consumable materials such as anesthetic medication and suture and sterile instruments. Related systems that must be integrated are facilities and utilities such as electricity, lighting, plumbing and waste management and even laundry. But especially in low and middle income countries (LMICs) lack of any one of these may be rate-limiting. The World Health Organization (WHO) has developed situational analyses and checklists for first level district hospitals to identify missing elements. A siloed approach cannot solve a systems problem. However, to scale up rapidly and to develop and sustain quality standards, a holistic "ecosystem" approach, including local and global professional societies and advocacy organizations will need to become engaged. Copyright

  7. Impact of Virtual Learning Environment (VLE): A Technological Approach to Genetics Teaching on High School Students' Content Knowledge, Self-Efficacy and Career Goal Aspirations

    Science.gov (United States)

    Kandi, Kamala M.

    2013-01-01

    This study examines the effect of a technology-based instructional tool "Geniverse" on the content knowledge gains, Science Self-Efficacy, Technology Self-Efficacy, and Career Goal Aspirations among 283 high school learners. The study was conducted in four urban high schools, two of which have achieved Adequate Yearly Progress (AYP) and…

  8. To What Extent Does Participation in Extracurricular Music Affect the Future Aspirations of 11-12-Year-Olds? A Small-Scale Investigation

    Science.gov (United States)

    Denny, Eleanor

    2007-01-01

    I undertook this project as a 12-year-old student while studying research methods at the Children's Research Centre at the Open University. It has already been shown that doing music improves children's Mathematics and English scores. The aim of this study was to find out if it also raises the aspirations of the children taking part. A…

  9. Clinical Experience Using the Mann Assessment of Swallowing Ability for Identification of Patients at Risk for Aspiration in a Mixed-Disease Population

    Science.gov (United States)

    Gonzalez-Fernandez, Marlis; Sein, Michael T.; Palmer, Jeffrey B.

    2011-01-01

    Purpose: To determine the clinical performance characteristics of the Mann Assessment of Swallowing Ability (MASA) for predicting aspiration (determined by videofluoroscopic swallowing study [VFSS]) in a mixed population. Method: We selected 133 cases clinically evaluated using MASA and VFSS from January through June 2007. Ordinal risk rating…

  10. Comparison of diagnostic accuracy between endometrial curettage and pipelle aspiration biopsy in patients treated with progestin for endometrial hyperplasia: a Korean Gynecologic Oncology Group Study (KGOG 2019).

    Science.gov (United States)

    Kim, Mi Kyoung; Seong, Seok Ju; Lee, Taek Sang; Ki, Kyung-Do; Lim, Myong Cheol; Kim, Yun Hwan; Kim, Kidong; Joo, Won Duk

    2015-10-01

    A prospective multicenter trial has been started in Korea to evaluate the diagnostic accuracy of endometrial aspiration biopsy compared with dilatation and curettage in patients treated with progestin for endometrial hyperplasia. For conservative treatment of endometrial hyperplasia, orally administered progestins are most commonly used method with various treatment regimens and more recently, the levonorgestrel-releasing intrauterine system also has been used successfully to treat endometrial hyperplasia. However, there is no report about the accuracy of endometrial sampling during hormonal treatment for follow-up evaluation of endometrial hyperplasia. Patients with histologically confirmed endometrial hyperplasia are offered hormonal treatment with any one of the following three options: oral medroxyprogesterone acetate 10 mg/day for 14 days per cycle, continuous oral medroxyprogesterone acetate 10 mg/day or insertion of levonorgestrel-releasing intrauterine system. Histological surveillance is performed at 3 months or 6 months following initial treatment. Endometrial tissues are obtained via endometrial aspiration biopsy using a pipelle and dilatation and curettage. In the case of levonorgestrel-releasing intrauterine system, endometrial aspiration biopsy will be done with levonorgestrel-releasing intrauterine system in uterus and then, after the removal of levonorgestrel-releasing intrauterine system, dilatation and curettage will be done. The biopsy findings will be compared. The primary endpoint is to compare the pathological outcome of endometrial aspiration with dilatation and curettage. The secondary endpoint is the response rate with three types of progestin treatment at 6 months.

  11. [Intestinal occlusion secondary to a retained surgical item].

    Science.gov (United States)

    Balcázar-Rincón, Luis Ernesto; Gordillo Gómez, Enrique Alejandro; Ramírez-Alcántara, Yunis Lourdes

    Retained surgical items after a surgical procedure is a real, existing, and preventable problem that affects the safety of the surgical patient. Its incidence is not exactly known due to under-reporting of occurrence, due to the potential risk of lawsuits. A 31 year-old women that had an elective caesarean, apparently without complications. In the immediate post-operative period, clinical features appeared that were compatible with intestinal obstruction, such as inability to channel gas, bloating, abdominal pain and vigorous peristalsis. The diagnosis is made by the recent history of abdominal-pelvic surgery and the finding of a foreign body on a simple x-ray of the abdomen. The patient was operated upon, with a satisfactory outcome, and was discharged 5 days later. A retained surgical instrument is an under-reported event that represents a medical-legal problem, leading to various complications, including death if it is not diagnosed and treated early. It is important to know the risk factors and adopt a culture of prevention through perioperative monitoring of equipment and instruments used during the surgical act. Copyright © 2015 Academia Mexicana de Cirugía A.C. Publicado por Masson Doyma México S.A. All rights reserved.

  12. Aspirations of a Leader: A Biographical History through a Narrative Lens

    Science.gov (United States)

    Peeler, Eleanor

    2012-01-01

    Biography is often construed as life story, life history or memoir. The author who narrates the life of another the biographer may skim the surface to relate the events that occurred during the subject's life or dig deeply to explore the social and political issues that shaped her/his development. The subject of this biography is a man who grasped…

  13. A CLINICAL STUDY OF INTESTINAL OBSTRUCTION AND ITS SURGICAL MANAGEMENT IN RURAL POPULATION

    Directory of Open Access Journals (Sweden)

    Naveen

    2013-05-01

    Full Text Available ABSTRACT: BACKGROUND: The diagnosis and management of the patient with i ntestinal obstruction is one of the more challenging emergenc y that a general surgeon can come across. Although the mortality due to acute intestinal obst ruction is decreasing in urban areas due to early presentation and prompt medical attention, the same is not true in rural population because of late presentation with complications. With better unders tanding of pathophysiology, improvement in diagnostic techniques, fluid and electrolyte correc tion, much potent antibiotics and surgical management the complications arising due to late pr esentation can be limited. However, still mortality ranges from 3% for simple obstruction to as much as 30% when there is vascular compromise or perforation of the obstructed bowel . This is further influenced by the clinical setting and related co-morbidities. OBJECTIVES: To study va rious causes, clinical features, and modalities of treatment of intestinal obstruction and their ou tcome. METHODOLOGY: A total of 50 cases of intestinal obstruction, after admission in our hosp ital that were surgically managed, were chosen by simple random technique for the study. Statistic al analysis was done using SPSS software. RESULTS: Intestinal obstruction is more common in the age gr oup of 30-60 years. Small bowel obstruction is more common than large bowel obstruc tion. Four cardinal features of intestinal obstruction are pain abdomen, vomiting, distension and constipation. Most common etiological factor is postoperative adhesions followed by abdom inal hernia. Malignancy as a cause for obstruction is more common in large bowel than smal l bowel. Intravenous fluids and electrolytes, gastrointestinal aspiration, antibiotics and timed appropriate surgery are still the mainstay of treatment. CONCLUSION: Intestinal obstruction still remains a common and i mportant surgical emergency. Obstruction due to adhesions is increasi ng in incidence due to

  14. Sensorization of a surgical robotic instrument for force sensing

    Science.gov (United States)

    Shahzada, Kaspar S.; Yurkewich, Aaron; Xu, Ran; Patel, Rajni V.

    2016-03-01

    This paper presents the development and application of an approach for sensorizing a surgical robotic instrument for two degree-of-freedom (DOF) lateral force sensing. The sensorized instrument is compatible with the da Vinci® Surgical System and can be used for skills assessment and force control in specific surgical tasks. The sensing technology utilizes a novel layout of four fiber Bragg grating (FBG) sensors attached to the shaft of a da Vinci® surgical instrument. The two cross-section layout is insensitive to error caused by combined force and torque loads, and the orientation of the sensors minimizes the condition number of the instrument's compliance matrix. To evaluate the instrument's sensing capabilities, its performance was tested using a commercially available force-torque sensor, and showed a resolution of 0.05N at 1 kHz sampling rate. The performance of the sensorized instrument was evaluated by performing three surgical tasks on phantom tissue using the da Vinci® system with the da Vinci Research Kit (dVRK): tissue palpation, knot tightening during suturing and Hem-O-Lok® tightening during knotless suturing. The tasks were designed to demonstrate the robustness of the sensorized force measurement approach. The paper reports the results of further evaluation by a group of expert and novice surgeons performing the three tasks mentioned above.

  15. When Aspirations Exceed Expectations: Quixotic Hope Increases Depression among Students.

    Directory of Open Access Journals (Sweden)

    Katharine H Greenaway

    Full Text Available A paradox exists in modern schooling: students are simultaneously more positive about the future and more depressed than ever. We suggest that these two phenomena may be linked. Two studies demonstrated that students are more likely to be depressed when educational aspirations exceed expectations. In Study 1 (N = 85 aspiring to a thesis grade higher than one expected predicted greater depression at the beginning and end of the academic year. In Study 2 (N = 2820 aspiring to a level of education (e.g., attending college higher than one expected to achieve predicted greater depression cross-sectionally and five years later. In both cases the negative effects of aspiring high while expecting low persisted even after controlling for whether or not students achieved their educational aspirations. These findings highlight the danger of teaching students to aspire higher without also investing time and money to ensure that students can reasonably expect to achieve their educational goals.

  16. When Aspirations Exceed Expectations: Quixotic Hope Increases Depression among Students.

    Science.gov (United States)

    Greenaway, Katharine H; Frye, Margaret; Cruwys, Tegan

    2015-01-01

    A paradox exists in modern schooling: students are simultaneously more positive about the future and more depressed than ever. We suggest that these two phenomena may be linked. Two studies demonstrated that students are more likely to be depressed when educational aspirations exceed expectations. In Study 1 (N = 85) aspiring to a thesis grade higher than one expected predicted greater depression at the beginning and end of the academic year. In Study 2 (N = 2820) aspiring to a level of education (e.g., attending college) higher than one expected to achieve predicted greater depression cross-sectionally and five years later. In both cases the negative effects of aspiring high while expecting low persisted even after controlling for whether or not students achieved their educational aspirations. These findings highlight the danger of teaching students to aspire higher without also investing time and money to ensure that students can reasonably expect to achieve their educational goals.

  17. Mycobacterium avium complex olecranon bursitis resolves without antimicrobials or surgical intervention: A case report and review of the literature

    Science.gov (United States)

    Working, Selene; Tyser, Andrew; Levy, Dana

    2015-01-01

    Introduction Nontuberculous mycobacteria are an uncommon cause of septic olecranon bursitis, though cases have increasingly been described in both immunocompromised and immunocompetent hosts. Guidelines recommend a combination of surgical resection and antimicrobials for treatment. This case is the first reported case of nontuberculous mycobacterial olecranon bursitis that resolved without medical or surgical intervention. Case presentation A 67-year-old female developed a painless, fluctuant swelling of the olecranon bursa following blunt trauma to the elbow. Due to persistent bursal swelling, she underwent three separate therapeutic bursal aspirations, two involving intrabursal steroid injection. After the third aspiration, the bursa became erythematous and severely swollen, and bursal fluid grew Mycobacterium avium complex. Triple-drug antimycobacterial therapy was initiated, but discontinued abruptly due to a rash. Surgery was not performed. The patient was observed off antimicrobials, and gradually clinically improved with a compressive dressing. By 14 months after initial presentation, clinical exam revealed complete resolution of the previously erythematous bursal mass. Discussion This is the first reported case of nontuberculous mycobacterial olecranon bursitis managed successfully without surgery or antimicrobials. Musculoskeletal nontuberculous mycobacterial infections are challenging given the lack of clinical data about optimal duration and choice of antimicrobials or the role of surgery. Additionally, the potential toxicity and drug interactions of antimycobacterials are not insignificant and warrant close monitoring if treatment is pursued. Conclusion This case raises an important clinical question of whether close observation off antimicrobials is appropriate in select cases of immunocompetent patients with localized atypical mycobacterial disease of soft tissue and skeletal structures. PMID:26793457

  18. A review of wide surgical excision of hidradenitis suppurativa

    Directory of Open Access Journals (Sweden)

    Alharbi Ziyad

    2012-06-01

    Full Text Available Abstract Background Hidradenitis suppurativa (HS is a chronic inflammatory cutaneous disorder that involves the infundibular terminal follicles in areas rich of apocrine glands. It can be associated with fistulating sinus, scarring and abscesses formation. Hidradenitis suppurativa is a challenging aspect and requires a proper treatment plan which may involve different specialties. We present herein the option of surgical treatment involving wide surgical excision and methods of reconstruction as well as the rate of recurrence. Furthermore, review of the literature regarding surgical treatment of hidradenitis suppurativa is provided. Methods A retrospective analysis reviewed 50 operative procedures for 32 patients in 5 anatomical sites. These anatomical sites have been divided to 23 sites involving the axilla, 17 sites involving the inguinal region and 8 sites involving the perianal/perineal area, 1 site involving the gluteal region and 1 site involving the trunk region. Results Twenty six patients (81, 25 % showed no recurrence after surgery and the average time of hospital stay period was 5 days. Recurrence was observed only in 6 patients (18, 75 %. Conclusion Elimination of the acute inflammatory process should occur in advance, including the use of antibiotics and minor surgeries such as abscess drainage with proper irrigations. After stabilizing the acute phase, wide surgical excision is recommended. Herein, planning of surgical reconstruction should be initiated to achieve the best outcome and consequently decreasing the risk of recurrence and complications after surgery.

  19. Risk Factors for Aspiration Pneumonia in Older Adults

    OpenAIRE

    2015-01-01

    BackgroundsAspiration pneumonia is a dominant form of community-acquired and healthcare-associated pneumonia, and a leading cause of death among ageing populations. However, the risk factors for developing aspiration pneumonia in older adults have not been fully evaluated. The purpose of the present study was to determine the risk factors for aspiration pneumonia among the elderly.Methodology and Principal FindingsWe conducted an observational study using data from a nationwide survey of geri...

  20. Risk Factors for Aspiration Pneumonia in Older Adults

    OpenAIRE

    2015-01-01

    Backgrounds Aspiration pneumonia is a dominant form of community-acquired and healthcare-associated pneumonia, and a leading cause of death among ageing populations. However, the risk factors for developing aspiration pneumonia in older adults have not been fully evaluated. The purpose of the present study was to determine the risk factors for aspiration pneumonia among the elderly. Methodology and Principal Findings We conducted an observational study using data from a nationwide survey of g...

  1. Correlation of gastroesophageal reflex with aspiration pneumonia after surgery

    Energy Technology Data Exchange (ETDEWEB)

    Hirashima, Tokuji; Hashimoto, Hajime; Noro, Toshio; Takahashi, Tadao; Hino, Yasunori; Kuroiwa, Kouzirou [Tokyo Metropolitan Geriatric Medical Center (Japan)

    1996-08-01

    In order to elucidate the correlation of gastroesophageal reflex (GER) with aspiration pneumonia after surgery, 48 patients (mean, 75.6 years) with gastric cancer treated at the hospital from March, 1994 to December, 1994 were subjected to this prospective study. The pharyngeal stimulation test, nutritional assessment, radionuclide esophageal scintigraphy (34 cases) were performed before surgery and relationship between those results and aspiration pneumonia were studied. Aspiration pneumonia occurred in 3 cases, and all of them were in, significantly, poor nutritional status, compared with other. A significant increase in the frequency of GER was observed when a naso-gastric tube (NGT) was placed, but surprisingly, all the patients with aspiration pneumonia were 3 out of 4 patients who had continuous GER without NGT. It is noteworthy, continuous GER without NGT was significantly (p<0.001) affected postoperative aspiration pneumonia and impaired phalyngeal reflex was frequently correlated with development of aspiration pneumonia, when malnutritional status existed. (author)

  2. A Surgical View of Photodynamic Therapy in Oncology: A Review

    Science.gov (United States)

    Moghissi, K.; Dixon, Kate; Gibbins, Sally

    2015-01-01

    Clinical photodynamic therapy (PDT) has existed for over 30 years, and its scientific basis has been known and investigated for well over 100 years. The scientific foundation of PDT is solid and its application to cancer treatment for many common neoplastic lesions has been the subject of a huge number of clinical trials and observational studies. Yet its acceptance by many clinicians has suffered from its absence from the undergraduate and/or postgraduate education curricula of surgeons, physicians, and oncologists. Surgeons in a variety of specialties many with years of experience who are familiar with PDT bear witness in many thousands of publications to its safety and efficacy as well as to the unique role that it can play in the treatment of cancer with its targeting precision, its lack of collateral damage to healthy structures surrounding the treated lesions, and its usage within minimal access therapy. PDT is closely related to the fluorescence phenomenon used in photodiagnosis. This review aspires both to inform and to present the clinical aspect of PDT as seen by a surgeon. PMID:28824964

  3. Surgical innovation: the ethical agenda: A systematic review.

    Science.gov (United States)

    Broekman, Marike L; Carrière, Michelle E; Bredenoord, Annelien L

    2016-06-01

    The aim of the present article was to systematically review the ethics of surgical innovation and introduce the components of the learning health care system to guide future research and debate on surgical innovation.Although the call for evidence-based practice in surgery is increasingly high on the agenda, most surgeons feel that the format of the randomized controlled trial is not suitable for surgery. Innovation in surgery has aspects of, but should be distinguished from both research and clinical care and raises its own ethical challenges.To answer the question "What are the main ethical aspects of surgical innovation?", we systematically searched PubMed and Embase. Papers expressing an opinion, point of view, or position were included, that is, normative ethical papers.We included 59 studies discussing ethical aspects of surgical innovation. These studies discussed 4 major themes: oversight, informed consent, learning curve, and vulnerable patient groups. Although all papers addressed the ethical challenges raised by surgical innovation, surgeons hold no uniform view of surgical innovation, and there is no agreement on the distinction between innovation and research. Even though most agree to some sort of oversight, they offer different alternatives ranging from the formation of new surgical innovation committees to establishing national registries. Most agree that informed consent is necessary for innovative procedures and that surgeons should be adequately trained to assure their competence to tackle the learning curve problem. All papers agree that in case of vulnerable patients, alternatives must be found for the informed consent procedure.We suggest that the concept of the learning health care system might provide guidance for thinking about surgical innovation. The underlying rationale of the learning health care system is to improve the quality of health care by embedding research within clinical care. Two aspects of a learning health care system might

  4. Providing surgical care in Somalia: A model of task shifting

    Directory of Open Access Journals (Sweden)

    Ford Nathan P

    2011-07-01

    Full Text Available Abstract Background Somalia is one of the most political unstable countries in the world. Ongoing insecurity has forced an inconsistent medical response by the international community, with little data collection. This paper describes the "remote" model of surgical care by Medecins Sans Frontieres, in Guri-El, Somalia. The challenges of providing the necessary prerequisites for safe surgery are discussed as well as the successes and limitations of task shifting in this resource-limited context. Methods In January 2006, MSF opened a project in Guri-El located between Mogadishu and Galcayo. The objectives were to reduce mortality due to complications of pregnancy and childbirth and from violent and non-violent trauma. At the start of the program, expatriate surgeons and anesthesiologists established safe surgical practices and performed surgical procedures. After January 2008, expatriates were evacuated due to insecurity and surgical care has been provided by local Somalian doctors and nurses with periodic supervisory visits from expatriate staff. Results Between October 2006 and December 2009, 2086 operations were performed on 1602 patients. The majority (1049, 65% were male and the median age was 22 (interquartile range, 17-30. 1460 (70% of interventions were emergent. Trauma accounted for 76% (1585 of all surgical pathology; gunshot wounds accounted for 89% (584 of violent injuries. Operative mortality (0.5% of all surgical interventions was not higher when Somalian staff provided care compared to when expatriate surgeons and anesthesiologists. Conclusions The delivery of surgical care in any conflict-settings is difficult, but in situations where international support is limited, the challenges are more extreme. In this model, task shifting, or the provision of services by less trained cadres, was utilized and peri-operative mortality remained low demonstrating that safe surgical practices can be accomplished even without the presence of fully

  5. Virtual cystoscopy--a surgical planning and guidance tool.

    Science.gov (United States)

    Braticevici, Bogdan; Onu, Mihaela; Bengus, Florentin

    2006-03-01

    Image guided-surgery systems facilitates surgical planning phases of endoscopic procedures. In this paper, we used a software package for 3D surface model generation and vizualization of the urinary bladder, based on magnetic resonance (MR) cross sectional images of the pelvis. The patients group consisted in 6 patients diagnosed with urinary bladder tumour. They were submitted to MRI exam. Twelve consecutive cross sectional images of the pelvis were aquired (TR (repetition time) = 600 msec, TE (echo time) = 19 msec, slice thickness = 6 divided by 7 mm, FOV (field of view) = 36 cm. All these images were transferred to a personal computer running the 3DSlicer software. We obtained, for each patient, a 3D model of the pelvis including the urinary bladder. In This way, the surgical enviroment was simulated and we are able to investigate the bladder by virtual cystoscopy. The virtual endoscopy may be used as a tool in the preoperative training and in surgical planning.

  6. The surgical ensemble: choreography as a simulation and training tool.

    Science.gov (United States)

    Satava, Richard M; Hunter, Anne Marie

    2011-09-01

    Team training and interprofessional training have recently emerged as critical new simulations that enhance performance by coordinating communication, leadership, professional, and, to a certain extent, technical skills. In describing these new training tools, the term choreography has been loosely used, but no critical appraisal of the role of the science of choreography has been applied to a surgical procedure. By analogy, the surgical team, including anesthetists, surgeons, nurses, and technicians, constitutes a complete ensemble, whose physical actions and interactions constitute the "performance of surgery." There are very specific "elements" (tools) that are basic to choreography, such as space, timing, rhythm, energy, cues, transitions, and especially rehearsal. This review explores whether such a metaphor is appropriate and the possibility of applying the science of choreography to the surgical team in the operating theater.

  7. A standardized surgical technique for rat superior cervical ganglionectomy

    DEFF Research Database (Denmark)

    Savastano, Luis Emilio; Castro, Analía Elizabeth; Fitt, Marcos René

    2010-01-01

    injury. Despite having several experimental applications in the rat, a thorough description of a standardized procedure has never been published. Here, we provide a brief review of the principal features and experimental uses of the SCGx, the surgical anatomy of the neck and sympathetic cervical chain......, and a step-by-step description of how to consistently remove the superior cervical ganglia through the omohyoid muscle or the carotid triangle. Furthermore, we suggest procedures and precautions to be taken during and after surgery to optimize results and describe tools to validate surgical success. We...

  8. Post-operative urinary retention in a general surgical population

    DEFF Research Database (Denmark)

    Dreijer, Bjørn; Møller, Morten H; Bartholdy, Jens

    2011-01-01

    Post-operative urine retention is a frequent and serious complication. The aims of this study were to evaluate the prevalence of post-operative urinary retention in a general surgical population and to identify the perioperative risk factors for developing this condition.......Post-operative urine retention is a frequent and serious complication. The aims of this study were to evaluate the prevalence of post-operative urinary retention in a general surgical population and to identify the perioperative risk factors for developing this condition....

  9. Sublingual ranula: a closer look to its surgical management.

    Science.gov (United States)

    Mortellaro, Carmen; Dall'Oca, Susanna; Lucchina, Alberta Greco; Castiglia, Antonino; Farronato, Gianpietro; Fenini, Emanuele; Marenzi, Gaetano; Trosino, Oreste; Cafiero, Carlo; Sammartino, Gilberto

    2008-01-01

    Ranulas have been managed by various surgical methods, and the optimal treatment is still controversial. The aim of this study was to analyze a group of 124 surgically treated patients with intraoral ranula to assess 3 different methods: sublingual gland removal combined with the ranula excision, conventional marsupialization, and a variant of the marsupialization technique usually performed in our departments. Recurrence rate was 0% after radical treatment, 25.8% after marsupialization, and 12% after modified marsupialization. We suggest that conservative methods should always be considered as treatment of superficial oral ranulas. The modification of the conventional marsupialization by suturing the edges of the pseudocyst before unroofing of the lesion was demonstrated to be a useful technical strategy that simplifies and accelerates the surgical procedures and probably contributed to preventing recurrences.

  10. Dream Team - A pregraduate surgical talent development project

    DEFF Research Database (Denmark)

    Jensen, Rune Dall; Seyer-Hansen, Mikkel; Christensen, Mette Krogh

    Dream Team is an extracurricular pregraduate surgical talent development project founded in 2009 at Aarhus University Hospital, Denmark. It aims to identify and develop laparoscopic surgical talents during medical school. Dream Team contains two parts: 1) a weeklong boot camp where app. 10 % of 8th...... the mentorship the students will be in operation room at least once a week and participate as much as their skills allow. Dream Team differs from similar pregraduate programs as it selects the most talented students, but does the boot camp select the best and does the mentorship program provide optimal learning......? A PhD project aims to critically analyze and develop Dream Team. The PhD project is based on theories about deliberate practice[1] and social learning[2]. In addition, we compare surgical talent development[3][4] with talent development in elite sport in order to inspire, refine and develop Dream Team...

  11. Surgical stabilization of internal pneumatic stabilization? A prospective randomized study of management of severe flail chest patients.

    Science.gov (United States)

    Tanaka, Hideharu; Yukioka, Tetsuo; Yamaguti, Yoshihiro; Shimizu, Syoichiro; Goto, Hideaki; Matsuda, Hiroharu; Shimazaki, Syuji

    2002-04-01

    We compared the clinical efficacy of surgical stabilization and internal pneumatic stabilization in severe flail chest patients who required prolonged ventilatory support. Thirty-seven consecutive severe flail chest patients who required mechanical ventilation were enrolled in this study. All the patients received identical respiratory management, including end-tracheal intubation, mechanical ventilation, continuous epidural anesthesia, analgesia, bronchoscopic aspiration, postural drainage, and pulmonary hygiene. At 5 days after injury, surgical stabilization with Judet struts (S group, n = 18) or internal pneumatic stabilization (I group, n = 19) was randomly assigned. Most respiratory management was identical between the two groups except the surgical procedure. Statistical analysis using two-way analysis of variance and Tukey's test was used to compare the groups. Age, sex, Injury Severity Score, chest Abbreviated Injury Score, number of rib fractures, severity of lung contusion, and Pao2/Fio2 ratio at admission were all equivalent in the two groups. The S group showed a shorter ventilatory period (10.8 +/- 3.4 days) than the I group (18.3 +/- 7.4 days) (p < 0.05), shorter intensive care unit stay (S group, 16.5 +/- 7.4 days; I group, 26.8 +/- 13.2 days; p < 0.05), and lower incidence of pneumonia (S group, 24%; I group, 77%; p < 0.05). Percent forced vital capacity was higher in the S group at 1 month and thereafter (p < 0.05). The percentage of patients who had returned to full-time employment at 6 months was significantly higher in the S group (11 of 18) than in the I group (1 of 19). This study proved that in severe flail chest patients, surgical stabilization using Judet struts has beneficial effects with respect to less ventilatory support, lower incidence of pneumonia, shorter trauma intensive care unit stay, and reduced medical cost than internal fixation. Moreover, surgical stabilization with Judet struts improved percent forced vital capacity from the

  12. Changing educational aspirations of children living in poverty in Ethiopia

    OpenAIRE

    2010-01-01

    Using both qualitative and quantitative data, this paper examines the changing educational and occupational aspirations and educational achievements of children living in poor communities in Ethiopia. The results suggest that children had high aspirations at an earlier age but that these changed later, with poverty rarely influencing their earlier aspirations but having a strong impact later on. Children with high educational achievement, mostly urban children and some rural girls, maintained...

  13. Does Living Closer to a University Increase Educational Attainment? A Longitudinal Study of Aspirations, University Entry, and Elite University Enrolment of Australian Youth.

    Science.gov (United States)

    Parker, Philip D; Jerrim, John; Anders, Jake; Astell-Burt, Thomas

    2016-06-01

    Geography remains a critical factor that shapes the development of aspirations, attainment, and choice in young people. We focus on the role of geography on university entry and aspirations due to the increasing requirement in society for a higher education qualification for access to prestigious positions in society. Using a large representative longitudinal database (N = 11,999; 50 % male; 27 % provincial or rural; 2 % Indigenous) of Australia youth we explore the association between distance to a university campus and the critical attainment outcomes of university entry and enrolment in an elite university as well as critical predictors of these outcomes in access to information resources (i.e., university outreach programs) and university aspirations. In doing so, we provide new insight into distance effects, and the extent that these are due to selection, cost, and community influence. Our findings suggest that distance is significantly associated with both university expectations and entrance, with an especially large impact upon young people from low socioeconomic backgrounds. However, we also find little evidence that distance is related to attending a university led information session. Our conclusion is that distance effects cannot be fully explained by selection in terms of academic achievement and socioeconomic status, and that anticipatory decisions and costs are the most likely drivers of the distance effect.

  14. [The immediate interpretation for fine-needle aspiration cytology].

    Science.gov (United States)

    Chang, M C; Ho, W L

    1993-11-01

    From December 1990 to November 1992, 2005 cases of immediate interpretation for fine-needle aspiration (FNA) cytology were performed, of which 727 cases were confirmed by surgical pathology. A mobile cytologic laboratory (a cart loaded with a dual viewing microscope, Liu's staining solutions, hair dryer, and slides) can be moved to the Out-patient Department, wards and Computed Tomography room, where clinicians perform aspiration and pathologists read smears. Immediate verbal diagnoses are documented to patients' charts and listed in cytopathologic files. Immediate interpretation in this entire series yielded a sensitivity 92.5%; specificity, 98.1%; false-positive rate, 1.1%; false-negative rate, 3.2%; positive predictive value (PV), 97.3%; negative PV, 94.7% and efficiency, 95.7%. The cause of false-negative results in the 23 cases probably came from the hesitation in making an immediate diagnosis. Most of these cases were malignant lymphoma or breast carcinoma. The roles of immediate cytodiagnosis are (1) to decrease the inadequate rate of FNA specimens; (2) to render preliminary diagnosis for clinicians to make decisions; (3) to provide on-site teaching material for both clinicians and pathology residents to better understand clinicopathological correlations; (4) to act as the initial diagnostic procedure in the evaluation of a superficial palpable mass. This study shows that immediate interpretation for FNA cytology is a simple, rapid, accurate and noninvasive diagnostic procedure that can be routinely used for superficial palpable masses.

  15. Diagnostic Efficacy of Fine Needle Aspiration in Parotid Mass

    Directory of Open Access Journals (Sweden)

    Ebrahim Razmpa

    2010-10-01

    Full Text Available Introduction: The preoperative diagnostic evaluation of the parotid lesion is a valuable aid in planning the operation and the approach to intervention. Among different diagnostic tools, Fine Needle Aspiration has a key role. However, the exact efficacy of this technique in our center had not been thoroughly investigated. Materials and Methods: Between January 2000 and June 2007 a subset of 64 patients who had agreed to undergo preoperative FNAB was selected. The FNAB diagnoses were compared with those of the surgical specimens as the gold standard. Then, sensitivity, specificity, predictive value, and pertinent characteristics of the patients were evaluated. Finally, the results were analyzed with SPSS version14. Results: During the study period, 81 patients underwent parotidectomy, only 64 of whom had the FNA before surgery, so only the data collected from 64 patients were evaluated. The most common clinical presentation 75% (48 patients was a parotid mass. The second common presentation was facial paralysis at 17.2% (11 patients, followed by pain at 7.8%.  The result of FNA sensitivity was 82.5% and specificity was 93.3%. The accuracy of the test was 87.5%. Positive predictive value was 93.3% and negative predictive value was 82.35%. Conclusion: Fine-needle aspiration cytology is a reliable method in the evaluation of parotid tumors with a fairly high specificity and sensitivity rate.

  16. Dream Team - A pregraduate surgical talent development project

    DEFF Research Database (Denmark)

    Jensen, Rune Dall; Seyer-Hansen, Mikkel; Christensen, Mette Krogh

    . This presentation will present preliminary results from the PhD project. [1] Ericsson, Anders. The Cambridge Handbook of Expertise and Expert Performance. Cambridge University Press. 2006 [2] Wenger, Etienne. Communities of practice. Learning, meaning, and identity. Cambridge University Press. 1998 [3] Thomas, W......Dream Team is an extracurricular pregraduate surgical talent development project founded in 2009 at Aarhus University Hospital, Denmark. It aims to identify and develop laparoscopic surgical talents during medical school. Dream Team contains two parts: 1) a weeklong boot camp where app. 10 % of 8th......? A PhD project aims to critically analyze and develop Dream Team. The PhD project is based on theories about deliberate practice[1] and social learning[2]. In addition, we compare surgical talent development[3][4] with talent development in elite sport in order to inspire, refine and develop Dream Team...

  17. Excessive Surgical Adhesive Mimicking Aortic Root Abscess: A Case Report.

    Science.gov (United States)

    Silverton, Natalie A; Bull, David A; Morrissey, Candice K

    2017-07-15

    Aortic root abscess is a complication of aortic valve endocarditis that is associated with a high morbidity and mortality. The diagnosis usually is made with transesophageal echocardiography, which is highly sensitive and specific for the disease. We present a case of suspected aortic root abscess 1 week after mechanical aortic valve replacement for native valve endocarditis. The diagnosis was made by the use of transesophageal echocardiography but surgical inspection revealed that the paravalvular fluid collection was excessive surgical adhesive. We discuss the clinical significance and differential diagnosis of aortic root abscess in the setting of infective endocarditis.

  18. Surgical patients travel longer distances than non-surgical patients to receive care at a rural hospital in Mozambique.

    Science.gov (United States)

    Faierman, Michelle L; Anderson, Jamie E; Assane, Americo; Bendix, Peter; Vaz, Fernando; Rose, John A; Funzamo, Carlos; Bickler, Stephen W; Noormahomed, Emilia V

    2015-01-01

    Surgical care is increasingly recognised as an important component of global health delivery. However, there are still major gaps in knowledge related to access to surgical care in low-income countries. In this study, we compare distances travelled by surgical patients with patients seeking other medical services at a first-level hospital in rural Mozambique. Data were collected on all inpatients at Hospital Rural de Chókwè in rural Mozambique between 20 June 2012 and 3 August 2012. Euclidean distances travelled by surgical versus non-surgical patients using coordinates of each patient's city of residence were compared. Data were analysed using ArcGIS 10 and STATA. In total, 500 patients were included. Almost one-half (47.6%) lived in the city where the hospital is based. By hospital ward, the majority (62.0%) of maternity patients came from within the hospital's city compared with only 35.2% of surgical patients. The average distance travelled was longest for surgical patients (42 km) compared with an average of 17 km for patients on all other wards. Patients seeking surgical care at this first-level hospital travel farther than patients seeking other services. While other patients may have access to at community clinics, surgical patients depend more heavily on the services available at first-level hospitals. © The Author 2014. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  19. Laser-Assisted Removal of Aspirated Thumbtacks by Flexible Bronchoscopy

    Directory of Open Access Journals (Sweden)

    Oren Fruchter

    2010-01-01

    Objectives. To describe a technique for removal of sharp aspirated metal objects employing laser through flexible bronchoscopy. Methods. We report two patients in whom a new technique for removal of sharp aspirated metal objects utilizing Nd-Yag laser flexible bronchoscopy was used. Results. Successful and uncomplicated removal of the aspirated thumbpack by flexible bronchoscopy under conscious sedation was accomplished in the two patients described. Both patients were discharged within 24 hours. Conclusions. In patients with aspirated thumbtack laser-assisted breakage of the object through flexible bronchoscopy may obviate the need for rigid bronchoscopy or thoracotomy.

  20. The surgical treatment of a rare complication: gallstone ileus.

    Science.gov (United States)

    Donati, Marcello; Cardì, Francesco; Brancato, Giovanna; Calò, Piergiorgio; Donati, Angelo

    2010-01-01

    The authors describe 3 cases of gallstone ileus observed in two different hospitals and evaluate the current rarity of this complication of the biliary lithiasis and/or of cholangiocarcinomas. There were two cases of stones at the ileal level and one case in the left colon. In one case a single surgical intervention was carried out while in the other a two-step strategy was adopted. Notwithstanding the fact that the correct strategy to adopt is still controversial in literature, the authors discuss the single and double step strategies and propose that the second intervention of the 2-step strategy should not be performed in high risk surgical patients.

  1. Self-Administered Lidocaine Gel for Pain Control With First-Trimester Surgical Abortion: A Randomized Controlled Trial.

    Science.gov (United States)

    Conti, Jennifer A; Lerma, Klaira; Shaw, Kate A; Blumenthal, Paul D

    2016-08-01

    To compare pain control at various time points during first-trimester surgical abortion using a patient-administered lidocaine gel compared with a traditional lidocaine paracervical block. We conducted a randomized controlled trial of women undergoing surgical abortion at less than 12 weeks of gestation in an outpatient setting. The primary outcome was pain at cervical dilation as measured on a 100-mm visual analog scale. A sample size of 142 participants was planned to detect a 15-mm or greater difference on the 100-mm visual analog scale with 90% power and a significance level of .025, adding 10% for participant dropout and protocol violations. Participants received either 12 mL of a 1% lidocaine paracervical block or 20 mL of a self-administered, 2% lidocaine gel 20-30 minutes before procedure initiation. Secondary outcomes included anticipated pain, baseline pain, pain with speculum and tenaculum placement, pain after suction aspiration, and pain 30-45 minutes postoperatively. From April to October 2015, a total of 142 women were enrolled (68 in the paracervical block group, 69 in the gel group, and five not analyzed as a result of participant withdrawal). Sociodemographic characteristics were similar between groups. The mean pain score with cervical dilation was 60 mm (95% confidence interval [CI] 54-66) in the paracervical block group and 64 mm (95% CI 59-69) in the gel group (P=.3). There was no significant difference between mean pain scores at any time points measured. Self-administration of lidocaine gel before first-trimester surgical abortion is noninferior to a traditional paracervical lidocaine block and should be considered as an alternative, noninvasive approach to pain control for first-trimester surgical abortion. ClinicalTrials.gov, https://clinicaltrials.gov, NCT02447029.

  2. Is fine needle aspiration cytology a useful diagnostic tool for granular cell tumors? A cytohistological review with emphasis on pitfalls

    Directory of Open Access Journals (Sweden)

    Jason Koshy

    2014-01-01

    Full Text Available Background: Granular cell tumors (GCT formerly known as Abrikossoff tumor or granular cell myoblastoma, are rare neoplasms encountered in the fine needle aspiration (FNA service. Named because of their highly granular cytoplasm which is invariably positive for the S-100 antibody, the classic GCT is thought to be of neural origin. The cytomorphological features range from highly cellular to scanty cellular smears with dispersed polygonal tumor cells. The cells have abundant eosinophilic granular cytoplasm, eccentric round to oval vesicular nuclei with small inconspicuous nucleoli. The fragility of the cells can result in many stripped nuclei in a granular background. The differential diagnosis occasionally can range from a benign or reactive process to features that are suspicious for malignancy. Some of the concerning cytologic features include necrosis, mitoses and nuclear pleomorphism. Methods: We identified 6 cases of suspected GCT on cytology within the last 10 years and compared them to their final histologic diagnoses. Results: Four had histologic correlation of GCT including one case that was suspicious for GCT on cytology and called atypical with features concerning for a malignant neoplasm. Of the other two cases where GCT was suspected, one showed breast tissue with fibrocystic changes, and the other was a Hurthle cell adenoma of the thyroid. Conclusions: These results imply that FNA has utility in the diagnosis of GCT, and should be included in the differential diagnoses when cells with abundant granular cytoplasm are seen on cytology. Careful attention to cytologic atypia, signs of reactive changes, use of immunohistochemistry, and clinical correlation are helpful in arriving at a definite diagnosis on FNA cytology.

  3. Surgical aortic-valve replacement with a transcatheter implant.

    Science.gov (United States)

    Nowell, Justin L; Dewhurst, Alex; van Besouw, Jean-Pierre; Jahangiri, Marjan

    2011-04-01

    We describe a bailout procedure when surgical aortic-valve replacement was not possible due to severe calcification of the ascending aorta and the root and a very small annulus. A 21-mm CoreValve Revalving prosthesis was inserted via the aortotomy in the presence of a mitral prosthesis.

  4. Incisional endometriosis: Diagnosed by fine needle aspiration cytology

    Directory of Open Access Journals (Sweden)

    P Veda

    2010-01-01

    Full Text Available Incisional endometriosis (IE is a rare entity reported in 0.03-1.08% of women following obstetric or gynecologic surgeries. Most cases reported in literature have appeared after cesarean sections and were often clinically mistaken for hernia, abscess, suture granuloma or lipoma. We hereby report a case of IE following a second trimester hysterotomy, which was diagnosed by fine needle aspiration cytology (FNAC. Our patient was 26 years old, presenting with a mass over anterior abdominal wall, associated with incapacitating pain during each menstrual cycle. FNAC showed epithelial cells, stromal cells and hemosiderin laden macrophages. Based on the typical history, clinical and cytological features, the diagnosis of IE was established. Wide surgical excision was done and the resulting rectus sheath defect was repaired. Patient was followed for 6 months during which time she was symptom free. This article also reviews the spectrum of cytological features and the rare possibility of malignant transformation that can occur in IE.

  5. Incisional endometriosis: diagnosed by fine needle aspiration cytology.

    Science.gov (United States)

    Veda, P; Srinivasaiah, M

    2010-07-01

    Incisional endometriosis (IE) is a rare entity reported in 0.03-1.08% of women following obstetric or gynecologic surgeries. Most cases reported in literature have appeared after cesarean sections and were often clinically mistaken for hernia, abscess, suture granuloma or lipoma. We hereby report a case of IE following a second trimester hysterotomy, which was diagnosed by fine needle aspiration cytology (FNAC). Our patient was 26 years old, presenting with a mass over anterior abdominal wall, associated with incapacitating pain during each menstrual cycle. FNAC showed epithelial cells, stromal cells and hemosiderin laden macrophages. Based on the typical history, clinical and cytological features, the diagnosis of IE was established. Wide surgical excision was done and the resulting rectus sheath defect was repaired. Patient was followed for 6 months during which time she was symptom free. This article also reviews the spectrum of cytological features and the rare possibility of malignant transformation that can occur in IE.

  6. Predictive factors for early aspiration in liver abscess

    Institute of Scientific and Technical Information of China (English)

    Rustam Khan; Saeed Hamid; Shahab Abid; Wasim Jafri; Zaigham Abbas; Mohammed Islam; Hasnain Shah; Shaalan Beg

    2008-01-01

    AIM: To determine the predictive factors for early aspiration in liver abscess.METHODS: A retrospective analysis of all patients with liver abscess from 1995 to 2004 was performed. Abscess was diagnosed as amebic in 661 (68%) patients, pyogenic in 200 (21%), indeterminate in 73 (8%) and mixed in 32 (3%). Multiple logistic regression analysis was performed to determine predictive factors for aspiration of liver abscess.RESULTS: A total of 966 patients, 738 (76%) male, mean age 43 ± 17 years, were evaluated: 540 patients responded to medical therapy while adjunctive percutaneous aspiration was performed in 426 patients. Predictive factors for aspiration of liver abscess were: age ≥ 55 years, size of abscess ≥ 5 cm, involvement of both lobes of the liver and duration of symptoms ≥ 7 d. Hospital stay in the aspiration group was relatively longer than in the non aspiration group. Twelve patients died in the aspiration group and this mortality was not statistically significant when compared to the non aspiration group.CONCLUSION: Patients with advanced age, abscess size > 5 cm, both lobes of the liver involvement and duration of symptoms > 7 d were likely to undergo aspiration of the liver abscess, regardless of etiology.

  7. THE GONIOSETON, A SURGICAL-TREATMENT FOR CHRONIC GLAUCOMA

    NARCIS (Netherlands)

    VANDERVEEN, G; JONGEBLOED, WL; WORST, JGF

    1990-01-01

    A new and simple technique for glaucoma filtering surgery is presented. It is based on the introduction of a stainless steel microspiral or gonioseton into a goniopuncture by way of an ab interno procedure, minimising surgical trauma to the filtration area. Preliminary results are presented.

  8. Cutaneous endometriosis--Surgical presentations of a gynaecological condition.

    Science.gov (United States)

    Chiang, David T; Teh, Wan T

    2006-11-01

    Endometriosis is a common gynaecological condition; cutaneous endometriosis is a subtype of endometriosis. Although cutaneous endometriosis involving the abdominal wall is not common, preoperative diagnosis of cutaneous endometriosis can be easily mistaken for a suture granuloma, lipoma, abscess, cyst or hernia. We report two common surgical presentations of this gynaecological condition.

  9. THE GONIOSETON, A SURGICAL-TREATMENT FOR CHRONIC GLAUCOMA

    NARCIS (Netherlands)

    VANDERVEEN, G; JONGEBLOED, WL; WORST, JGF

    1990-01-01

    A new and simple technique for glaucoma filtering surgery is presented. It is based on the introduction of a stainless steel microspiral or gonioseton into a goniopuncture by way of an ab interno procedure, minimising surgical trauma to the filtration area. Preliminary results are presented.

  10. Silent aspiration: results of 2,000 video fluoroscopic evaluations.

    Science.gov (United States)

    Garon, Bernard R; Sierzant, Tess; Ormiston, Charles

    2009-08-01

    The purpose of this retrospective study of aspiration and the lack of a protective cough reflex at the vocal folds (silent aspiration) was to increase the awareness of nursing staffs of the diagnostic pathology groups associated with silent aspiration. Of the 2,000 patients evaluated in this study, 51% aspirated on the video fluoroscopic evaluation. Of the patients who aspirated, 55% had no protective cough reflex (silent aspiration). The diagnostic pathology groups with the highest rates of silent aspiration were brain cancer, brainstem stroke, head-neck cancer, pneumonia, dementia/Alzheimer, chronic obstructive lung disease, seizures, myocardial infarcts, neurodegenerative pathologies, right hemisphere stroke, closed head injury, and left hemisphere stroke. It is of high concern that the diagnostic groups identified in this research as having the highest risk of silent aspiration be viewed as "red-flag" patients by the nursing staff caring for them. Early nursing dysphagia screens, with close attention to the clinical symptoms associated with silent aspiration, and early referral for formal dysphagia evaluation are stressed.

  11. Academic Integrity in a Mandatory Physics Lab: The Influence of Post-Graduate Aspirations and Grade Point Averages

    Science.gov (United States)

    Gallant, Tricia Bertram; Anderson, Michael G.; Killoran, Christine

    2013-03-01

    Research on academic cheating by high school students and undergraduates suggests that many students will do whatever it takes, including violating ethical classroom standards, to not be left behind or to race to the top. This behavior may be exacerbated among pre-med and pre-health professional school students enrolled in laboratory classes because of the typical disconnect between these students, their instructors and the perceived legitimacy of the laboratory work. There is little research, however, that has investigated the relationship between high aspirations and academic conduct. This study fills this research gap by investigating the beliefs, perceptions and self-reported academic conduct of highly aspirational students and their peers in mandatory physics labs. The findings suggest that physics laboratory classes may face particular challenges with highly aspirational students and cheating, but the paper offers practical solutions for addressing them.

  12. Academic integrity in a mandatory physics lab: the influence of post-graduate aspirations and grade point averages.

    Science.gov (United States)

    Bertram Gallant, Tricia; Anderson, Michael G; Killoran, Christine

    2013-03-01

    Research on academic cheating by high school students and undergraduates suggests that many students will do whatever it takes, including violating ethical classroom standards, to not be left behind or to race to the top. This behavior may be exacerbated among pre-med and pre-health professional school students enrolled in laboratory classes because of the typical disconnect between these students, their instructors and the perceived legitimacy of the laboratory work. There is little research, however, that has investigated the relationship between high aspirations and academic conduct. This study fills this research gap by investigating the beliefs, perceptions and self-reported academic conduct of highly aspirational students and their peers in mandatory physics labs. The findings suggest that physics laboratory classes may face particular challenges with highly aspirational students and cheating, but the paper offers practical solutions for addressing them.

  13. Introduction of a New Diagnostic Method for Breast Cancer Based on Fine Needle Aspiration (FNA) Test Data and Combining Intelligent Systems

    Science.gov (United States)

    Fiuzy, Mohammad; Haddadnia, Javad; Mollania, Nasrin; Hashemian, Maryam; Hassanpour, Kazem

    2012-01-01

    Background Accurate Diagnosis of Breast Cancer is of prime importance. Fine Needle Aspiration test or "FNA”, which has been used for several years in Europe, is a simple, inexpensive, noninvasive and accurate technique for detecting breast cancer. Expending the suitable features of the Fine Needle Aspiration results is the most important diagnostic problem in early stages of breast cancer. In this study, we introduced a new algorithm that can detect breast cancer based on combining artificial intelligent system and Fine Needle Aspiration (FNA). Methods We studied the Features of Wisconsin Data Base Cancer which contained about 569 FNA test samples (212 patient samples (malignant) and 357 healthy samples (benign)). In this research, we combined Artificial Intelligence Approaches, such as Evolutionary Algorithm (EA) with Genetic Algorithm (GA), and also used Exact Classifier Systems (here by Fuzzy C-Means (FCM)) to separate malignant from benign samples. Furthermore, we examined artificial Neural Networks (NN) to identify the model and structure. This research proposed a new algorithm for an accurate diagnosis of breast cancer. Results According to Wisconsin Data Base Cancer (WDBC) data base, 62.75% of samples were benign, and 37.25% were malignant. After applying the proposed algorithm, we achieved high detection accuracy of about "96.579%” on 205 patients who were diagnosed as having breast cancer. It was found that the method had 93% sensitivity, 73% specialty, 65% positive predictive value, and 95% negative predictive value, respectively. If done by experts, Fine Needle Aspiration (FNA) can be a reliable replacement for open biopsy in palpable breast masses. Evaluation of FNA samples during aspiration can decrease insufficient samples. FNA can be the first line of diagnosis in women with breast masses, at least in deprived regions, and may increase health standards and clinical supervision of patients. Conclusion Such a smart, economical, non-invasive, rapid

  14. Acute Upper Limb Ischemia due to Cardiac Origin Thromboembolism: the Usefulness of Percutaneous Aspiration Thromboembolectomy via a Transbrachial Approach

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Sung Kwan; Kwak, Hyo Sung; Chung, Gyoung Ho; Han, Young Min [Chonbuk National University Hospital and Medical School, Chonju (Korea, Republic of)

    2011-10-15

    To evaluate the usefulness of percutaneous aspiration thromboembolectomy (PAT) via a transbrachial approach in patients with acute upper limb ischemia. From July 2004 to March 2008, eleven patients with acute upper limb ischemia were enrolled in this study. They were initially treated with thrombolysis (n = 1), PAT (n = 6), or both (n = 4) via a femoral artery approach. However, all of the patients had residual thrombus in the brachial artery, which was subsequently managed by PAT via the transbrachial approach for removal of residual emboli. Successful re-canalization after PAT via a transbrachial approach was achieved in all patients. Two patients experienced early complications: one experienced a massive hematoma of the upper arm due to incomplete compression and was treated by stent deployment. The other patient experienced a re-occlusion of the brachial artery the day after the procedure due to excessive manual compression of the puncture site, but did not show recurrence of ischemic symptoms in the artery of the upper arm. Clinical success with complete resolution of ischemic symptoms was achieved in all patients. PAT via a transbrachial approach is a safe and effective treatment for patients with acute upper limb ischemia.

  15. A fast-response aspirating probe for measurements of total temperature and pressure in transonic cryogenic wind tunnel

    Science.gov (United States)

    Ng, W.-F.; Rosson, J. C.

    1986-01-01

    A newly developed, 3-mm-diam, dual hot-wire aspirating probe was used to measure the time-resolved stagnation temperature and pressure in a transonic cryogenic wind tunnel. The probe consists of two coplanar constant temperature hot wires at different overheat ratios operating in a 1.5-mm-diam channel with a choked exit. Thus, the constant Mach number flow by the wires is influenced only by free-stream stagnation temperature and pressure. Diffusion of the free-stream Mach number to a lower value in the channel reduces the dynamic drag on the hot-wire. Frequency response of the present design is dc to 20 kHz. The probe was used to measure the unsteady wake shed from an oscillating airfoil tested in the 0.3-m Transonic Cryogenic Tunnel at NASA-Langley Research Center. The hot-wire lasted for more than ten hours before breaking, proving the ruggedness of the probe and the usefulness of the technique in a high dynamic pressure, transonic cryogenic wind tunnel. Typical data obtained from the experiment are presented after reduction to stagnation pressure and temperature.

  16. Fine-needle aspiration cytology of the breast: a preliminary report on telepathology through Internet multimedia electronic mail.

    Science.gov (United States)

    Della Mea, V; Puglisi, F; Bonzanini, M; Forti, S; Amoroso, V; Visentin, R; Dalla Palma, P; Beltrami, C A

    1997-06-01

    Telepathology is a field of telemedicine that enables the exchange of histologic and cytologic images for consultations among pathologists of two or more remote institutions, through a suitable communication channel. The Internet can connect several scientific and medical institutions because of the existence of a set of standard protocols that allow different computers to communicate; multimedia electronic mail is one such protocol, which allows asynchronous transmission of multimedia documents, i.e., including text, images, movies, and sounds. The aim of the present article is to test a novel approach in which Internet multimedia electronic mail is used as a communication medium to obtain an asynchronous telepathology tool for remote consultation. To assess the diagnostic validity of the method, 48 cases of fine-needle aspiration cytology of breast lesions were sent from Udine to Trento, Italy. Comparisons between local and remote diagnoses, and cytologic diagnoses versus subsequent histologic reports demonstrated that Internet multimedia electronic mail is suitable for remote consultation. Internet multimedia electronic mail thus presents an additional diagnostic tool that is easy to use, available on a wide range of computers, and inexpensive, because its cost is independent of distance.

  17. [Unilateral surgically assisted rapid maxillary expansion using a transpalatal distractor].

    NARCIS (Netherlands)

    Roelofs, J.; Breuning, K.H.; Spijker, A. van 't; Borstlap, W.A.; Berge, S.J.; Kuijpers-Jagtman, A.M.

    2010-01-01

    A 46-year-old woman was referred for orthodontic surgery consultation because ofa retrognathic maxilla, unilateral cross bite and functional, aesthetic and speech problems. The maxilla was widened unilaterally by unilateral surgically assisted rapid maxillary expansion with a bone-borne transpalatal

  18. Surgical dummy: a surrogate to live animal in teaching Veterinary ...

    African Journals Online (AJOL)

    for the institution and a number of legal suits have been filed against schools by students who ... the surgical cases admitted to the clinic are very few. A multiple of ... of cadavers to scientific discipline and the practice of euthanasia are almost.

  19. Use of fine needle aspirate from peripheral nerves of pure-neural leprosy for cytology and PCR to confirm the diagnosis: A pilot study

    Directory of Open Access Journals (Sweden)

    Abu Hena Hasanoor Reja

    2013-01-01

    Full Text Available Background: The diagnosis of pure neural leprosy (PNL remained subjective because of over-dependence of clinical expertise and a lack of simple yet reliable diagnostic tool. The criteria for diagnosis, proposed by Jardim et al., are not routinely done by clinicians in developing country as it involves invasive nerve biopsy and sophisticated anti-PGL-1 detection. We conducted a study using fine needle aspiration cytology (FNAC coupled with Ziehl Neelsen staining (ZN staining and Multiplex- Polymerase Chain Reaction (PCR specific for M. leprae for an objective diagnosis of pure neural leprosy (PNL, which may be simpler and yet reliable. Aim: The aim of the study is to couple FNAC with ZN staining and multiplex PCR to diagnose pure neural leprosy patients rapidly, in simpler and yet reliable way. Methods: Thirteen patients of PNL as diagnosed by two independent consultants were included as case, and 5 patients other than PNL were taken as control in the study. Fine needle aspiration was done on the affected nerve, and aspirates were evaluated for cytology, ZN staining and multiplex- PCR. Results: Out of the 13 cases where fine needle aspiration was done, M. leprae could be elicited in the nerve tissue aspirates in 5 cases (38.4% with the help of conventional acid-fast staining and 11 cases (84.6% with the help of multiplex PCR. On cytological examination of the aspirates, only 3 (23% cases showed specific epithelioid cells, whereas 8 (61.5% cases showed non-specific inflammation, and 2 (15.3% cases had no inflammatory cells. Conclusion: Our study demonstrates that in the field of laboratory diagnosis of PNL cases, FNAC in combination with ZN staining for acid-fast bacilli (AFB and Multiplex-PCR can provide a rapid and definitive diagnosis for the majority of PNL cases. FNAC is a less-invasive, outdoor-based and simpler technique than invasive nerve biopsy procedure. Thus, this study may enlighten the future path for easy and reliable diagnosis of

  20. Emission estimation of neat paradise tree oil combustion assisted with superheated hydrogen in a 4-stroke natural aspirated DICI engine

    Directory of Open Access Journals (Sweden)

    Sundararajan Karthikayan

    2016-01-01

    Full Text Available This research work investigates the use of neat paradise tree oil in a 4-stroke natural aspirated direct injection compression ignition engine assisted with the help of super-heated hydrogen (hydrogen in gaseous state or above its saturation temperature as a combustion improver. The high calorific gaseous fuel hydrogen gas was used as a combustion improver and admitted into the engine during the suction stroke. A 4-stroke single cylinder Diesel engine was chosen and its operating parameters were suitably modified. Neat paradise tree oil was admitted through standard injector of the engine and hydrogen was admitted through induction manifold. Inducted super-heated hydrogen was initiated the intermediate compounds combustion of neat paradise tree oil. This process offers higher temperature combustion and results in complete combustion of heavier molecules of neat paradise tree oil within shorter duration. The results of the experiment reveal that 40% higher NOx, 20% lower smoke, 5% lower CO, and 45% lower HC than that of neat paradise tree oil fuel operation and the admission of superheated hydrogen has improved the combustion characteristics of neat paradise tree oil. The investigation successfully proved that the application of neat paradise tree oil with 15% of hydrogen improver is possible under a regular Diesel engine with minimal engine modification.

  1. Primary small cell carcinoma of the parotid: Fine needle aspiration and immunohistochemical features of a neuroendocrine variant

    Directory of Open Access Journals (Sweden)

    Serdar Altinay

    2016-01-01

    Full Text Available Salivary gland small cell carcinoma (SGSmCC is extremely rare, accounting for less than 1% of salivary gland tumors. A 42-year-old female patient came to the outpatient clinic due to a mass localized in the left submandibular space and that had been growing since 3-4 months. The fine needle aspiration cytology (FNAC matched with small cell carcinoma (SmCC. As no other focus was detected by computerized tomography (CT, it was accepted as a primary neoplasm of the parotid gland. The histopathological assessment of the excised material and immunohistochemical staining demonstrated a neuroendocrine differentiation of SmCC. No recurrence was observed during the 54-month follow-up period. We believe this to be the second case of SmCC with neuroendocrine differantiation of the parotid glands reported in Turkύsh medical literature and will be added to the english database as one of the favorable SmCC cases.

  2. Public health care in Europe: moral aspirations, ideological obsessions, and structural pitfalls in a post-enlightenment culture.

    Science.gov (United States)

    Azguridienė, Guoda; Delkeskamp-Hayes, Corinna

    2015-04-01

    This essay focuses on the challenge European states have imposed on themselves, namely, to provide state-of-the-art health care equally to all and for less than market price. Continued endorsement of that challenge in these states hinges on their character as media democracies: the public is moved by a supposed morally warranted expectation that all should receive adequate health care at no significant personal cost. The structural and economic constraints that hamper such forms of healthcare delivery result in systems that are financially inefficient and fail to provide the quality of treatment patients are led to expect. This essay examines the tension between secular moral claims to social solidarity and the actual limits of accessibility to healthcare services. Its critical focus addresses both the difficulties that result from politicians invoking high moral ideals while framing their decisions around short-term political advantage, and the transformation of the Enlightenment's secular aspirations into a political ideology that distorts such moral ideals. This essay concludes that the commitments to very particular notions of equality and human dignity, which frame contemporary Europe's provision of publicly subsidized health care, have given rise to a governance that is morally incoherent and unsustainable. This failure of public health care in Europe can thus be read as one more belated manifestation of the epistemological and moral failure of the Enlightenment's secularizing project, a failure which should invite contemporary Europeans to honestly face the moral challenge of postmodernity.

  3. Limits of fine-needle aspiration cytology in diagnosing pilomatrixoma: a series of 25 cases with clinico-pathologic correlations.

    Science.gov (United States)

    Ieni, A; Todaro, P; Bonanno, A M; Catalano, F; Catalano, A; Tuccari, Giovanni

    2012-03-01

    Pilomatrixoma (PMX) is a benign, quite uncommon, skin neoplasm, which is frequently misdiagnosed by clinicians. We have analyzed 25 PMX to determine the agreement between clinical diagnosis, preoperative FNA characteristics, and corresponding histopathological specimens; moreover, reliable cytologic criteria for PMX and the differential diagnosis to avoid cytological pitfalls have been emphasized. By fine-needle aspiration (FNA) cytology a series of consecutive cases of PMX collected during last 5 years were studied. Smears were stained by Papanicolau and May-Grünwald-Giemsa. Patients affected by PMX were 11 males, 14 females (ratio 1:1.27); the mean age was 32.72 years with age range 3-78 years, being 72% (18/25) of patients 40 years or less. PMX was mainly distributed in the head-neck region (52%), scalp (16%), upper/lower arms (28%), and chest (4%). The observed diagnostic cytological features were represented by clusters of basaloid epithelial cells, shadow or ghost cells, inflammatory background, calcification, and giant cells. Unfortunately, not all these morphological aspects were always disclosed in smears, thus making the cytological preoperative diagnosis questionable and problematic. The experience of a well-trained cytopathologist should distinguish the relevant FNA features in terms of smear background, architecture, and cell morphology. The most dangerous mistake in FNA diagnosis of PMX regards a diagnosis of primary malignant or metastatic cutaneous lesions.

  4. Limits of fine-needle aspiration cytology in diagnosing pilomatrixoma: A series of 25 cases with clinico-pathologic correlations

    Directory of Open Access Journals (Sweden)

    A Ieni

    2012-01-01

    Full Text Available Background: Pilomatrixoma (PMX is a benign, quite uncommon, skin neoplasm, which is frequently misdiagnosed by clinicians. Aim: We have analyzed 25 PMX to determine the agreement between clinical diagnosis, preoperative FNA characteristics, and corresponding histopathological specimens; moreover, reliable cytologic criteria for PMX and the differential diagnosis to avoid cytological pitfalls have been emphasized. Materials and Methods: By fine-needle aspiration (FNA cytology a series of consecutive cases of PMX collected during last 5 years were studied. Smears were stained by Papanicolau and May-Grünwald-Giemsa. Results: Patients affected by PMX were 11 males, 14 females (ratio 1:1.27; the mean age was 32.72 years with age range 3-78 years, being 72% (18/25 of patients 40 years or less. PMX was mainly distributed in the head-neck region (52%, scalp (16%, upper/lower arms (28%, and chest (4%. The observed diagnostic cytological features were represented by clusters of basaloid epithelial cells, shadow or ghost cells, inflammatory background, calcification, and giant cells. Unfortunately, not all these morphological aspects were always disclosed in smears, thus making the cytological preoperative diagnosis questionable and problematic. Conclusions: The experience of a well-trained cytopathologist should distinguish the relevant FNA features in terms of smear background, architecture, and cell morphology. The most dangerous mistake in FNA diagnosis of PMX regards a diagnosis of primary malignant or metastatic cutaneous lesions.

  5. The blind nasotracheal aspiration method is not a useful tool for pathogen detection of pneumonia in children.

    Directory of Open Access Journals (Sweden)

    Tao Zhang

    Full Text Available BACKGROUND: Acute lower respiratory infection (ALRI is a major cause of hospitalization for children in China, while the etiological diagnosis of ALRI remains a challenge. This study was performed to evaluate the utility of the blind Nasotracheal aspiration (NTA in the pathogen detection in ALRI through an evaluation of the test's specificity. METHODOLOGY/PRINCIPAL FINDINGS: A hospital-based study of children ≤3 years was carried out from March 2006 through March 2007 in Suzhou University Affiliated Children's Hospital, including 379 cases with ALRI from the respiratory wards, and 394 controls receiving elective surgery. Nasopharyngeal swabs (NPS and NTA specimens were taken on admission. S. pneumoniae was isolated from 10.3% of NTA samples from ALRI children, H. influenzae from 15.3%, and M. catarrhalis from 4.7%. The false positive rate--the strains from NTA in control group children--was 8.4% (95% CI: 5.8%-11.4% for S. pneumoniae, 27.2% (95% CI: 22.7-31.5% for H. influenzae, and 22.1% (95% CI: 18.0%-26.2% for M. catarrhalis. The agreement between NPS and NTA in the control group was over 70%. CONCLUSION/SIGNIFICANCE: The blind NTA test is not a useful test for etiologic diagnosis of ALRI.

  6. PCR in the First Oropharynx Aspirate of the Newborn: A Possible Source for Identification of Congenital Infection Agents

    Directory of Open Access Journals (Sweden)

    D. A. L. PEDREIRA

    1997-11-01

    Full Text Available We present a case of prenatal diagnosis of congenital rubella. After birth, in addition to traditional serologic and clinical examinations to confirm the infection, we could identify the virus in the "first fluid aspirated from the oropharynx of the newborn", using polimerase chain reaction (PCR. We propose that this first oropharynx fluid (collected routinely immediately after birth could be used as a source for identification of various congenital infection agents, which may not always be easily identified by current methodsRelatamos um caso de diagnóstico pré-natal de rubéola congênita. Após o nascimento, além da confirmação feita através do exame físico e sorológico do recém-nascido, o vírus também pode ser demonstrado no primeiro fluido aspirado da orofaringe do recém-nascido, utilizando-se a reação em cadeia da polimerase (PCR. Sugerimos que este fluido (colhido rotineiramente no momento da reanimação neonatal possa ser utilizado na pesquisa de outros agentes infecciosos, que não são facilmente identificados por outros métodos

  7. A PROSPECTIVE STUDY OF MECONIUM ASPIRATION SYNDROME IN NEWBORNS IN A DISTRICT HOSPITAL IN SOUTHERN INDIA

    Directory of Open Access Journals (Sweden)

    Vijayalakshmi

    2015-06-01

    Full Text Available AIM OF THE STUDY: 1. To study the incidence and risk factors of MAS in neonates, 2. To study the outcome of using appropriate respiratory support (CPAP and mechanical ventilation in neonates with MAS and 3. To find the MAS related mortality rates. MATERIALS AND METHODS: T he present study was a single centre, descriptive, prospective and observational cross sectional study, done over a period of one year from 1 st of May 2014 to 30 th of April 2015. Only inborn cases with history of birth through MSAF were included. Gestation al age, birth weight, type of meconium, Apgar score at 1min and 5 min, duration of requirement of O2, CPAP, SIMV and number of deaths were recorded and analysed further. RESULTS: The study was performed over a period of 12 months from May 2014 to April 2015. During the study period, total number of deliveries in the district hospital was 9934. Total number of live births and still births were 9697 and 237 respectively. Total NICU a dmissions were 2237. Total MSAF cases were 563(5.67% of total deliveries. Total MAS cases were 220(2.21% of total deliveries and 39.08% of total MSAF cases. Percentage of MAS cases on ventilatory support was 35.45% (78/220, 0.19% of total number of deliv eries. Total MAS related deaths were 19(8.64% of total MAS cases. CONCLUSION: The incidence of MAS was 2.21% of total deliveries. Post maturity, low Apgar scores and thick MSAF were the risk factors associated with severe MAS and high mortality rate. Usi ng appropriate respiratory support in severe MAS cases had shown low mortality rate. The Mortality rate of MAS was 8.64%.

  8. A Companion for Aspirant Air Warriors: A Handbook for Personal Professional Study

    Science.gov (United States)

    2010-05-01

    as well. As the war neared, he was rapidly promoted to major general and took command of the Army air units in the Hawaiian Department. He...A Wed Oatlopmcnt PYogrom (or &llls!ic Mi$$11<$ o( lntet<C<Wneruol Rooge. Augenstein • ~porr o( AMlf<l<lticd CommluJofl. 8olq · Sk)""’’. Mhchel • Rt

  9. Surgical inpatient cancer-related mortality in a Nigerian tertiary ...

    African Journals Online (AJOL)

    Surgical inpatient cancer-related mortality in a Nigerian tertiary hospital. ... One hundred and eight (63.2 %) were male. The yearly mortality ... The leading causes of mortality were cancer of prostate 50(29.2 %) and breast cancer 40(23.4 %).

  10. BENIGN PAROTID TUMORS : AN EXPERIENCE IN A GENERAL SURGICAL UNIT

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    Vijaya

    2015-04-01

    Full Text Available Parotid tumors are mostly benign, but their evaluation and treatment require a thorough knowledge of the relevant anatomy and pathology. Surgical treatment of benign tumors is aimed at complete removal of the mass with facial nerve preservation. The aim of this study was to evaluate the post - operative complications of superficial parotidectomy in benign parotid tumors.

  11. Practice of stereotactic body radiotherapy in a developing country: Perception, aspiration, and limitation - A survey

    Directory of Open Access Journals (Sweden)

    S Rathod

    2016-01-01

    Full Text Available Background: Stereotactic body radiotherapy (SBRT is an effective and established modern technology now used more commonly. Radiation oncology personnel's (ROP opinion toward SBRT in the developing countries like India is unknown. Subjects and Methods: A 30 question survey evaluating ROP's profile, technological details, and SBRT's perceptive were seeked. Tata Memorial Center – ROP's email database was used. Results: Survey questionnaire was emailed to 500 ROP's and 224 ROP's were contactable. Majority of the responders were from corporate hospitals and half of responders had experience of 5 or more years of experience in radiation oncology. SBRT was practiced by 70% of responders and the majority had adopted SBRT in 2010 or later. Quick turn around time, high dose delivery and competitive market forces were major factors to adopt SBRT. Lung was the most common site practiced followed by prostate, spine, and liver. All SBRT users were keen to increase SBRT in practice and the majority of non-responders were planning to adapt SBRT in the recent future. Almost half of SBRT users were willing to share data and expertise for training others. Lack of infrastructure was the prime reason for not practicing SBRT. ROP's perceived physics, radiobiology as the biggest challenge in SBRT. International collaboration may be helpful. Conclusion: Use of SBRT is expected to increase in India. Limited experience with lack of infrastructure in public funded centers is a major limitation. Unmet need of infrastructure, training and guidelines is enormous and formulation of Indian SBRT consortium will help reforming at all levels.

  12. Practice of stereotactic body radiotherapy in a developing country: Perception, aspiration, and limitation - A survey.

    Science.gov (United States)

    Rathod, S; Munshi, A; Agarwal, J P

    2016-01-01

    Stereotactic body radiotherapy (SBRT) is an effective and established modern technology now used more commonly. Radiation oncology personnel's (ROP) opinion toward SBRT in the developing countries like India is unknown. A 30 question survey evaluating ROP's profile, technological details, and SBRT's perceptive were seeked. Tata Memorial Center - ROP's email database was used. Survey questionnaire was emailed to 500 ROP's and 224 ROP's were contactable. Majority of the responders were from corporate hospitals and half of responders had experience of 5 or more years of experience in radiation oncology. SBRT was practiced by 70% of responders and the majority had adopted SBRT in 2010 or later. Quick turn around time, high dose delivery and competitive market forces were major factors to adopt SBRT. Lung was the most common site practiced followed by prostate, spine, and liver. All SBRT users were keen to increase SBRT in practice and the majority of non-responders were planning to adapt SBRT in the recent future. Almost half of SBRT users were willing to share data and expertise for training others. Lack of infrastructure was the prime reason for not practicing SBRT. ROP's perceived physics, radiobiology as the biggest challenge in SBRT. International collaboration may be helpful. Use of SBRT is expected to increase in India. Limited experience with lack of infrastructure in public funded centers is a major limitation. Unmet need of infrastructure, training and guidelines is enormous and formulation of Indian SBRT consortium will help reforming at all levels.

  13. Gonioscopically Guided Nonpenetrating Cyclodialysis Cleft Repair: A Novel Surgical Technique

    Science.gov (United States)

    Rodrigues, Ian AS; Shah, Brinda; Goyal, Saurabh

    2017-01-01

    ABSTRACT Aim We present a novel surgical technique for repair of persistent and symptomatic cyclodialysis clefts refractory to conservative or minimally invasive treatment. Background Numerous surgical techniques have been described to close cyclodialysis clefts. The current standard approach involves intraocular repair of cyclodialysis clefts underneath a full-thickness scleral flap. Technique Our technique employs intraoperative use of a direct gonioscope to guide a nonpenetrating surgical repair. Subsequently, a significantly less invasive, nonpenetrating technique utilizing a partial-thickness scleral flap can be performed that reduces potential risks associated with intraocular surgery. The direct gonioscope is also used for confirmation of adequate surgical closure of the cyclodialysis cleft prior to completion of surgery. This technique has been successfully carried out to repair traumatic chronic cyclodialysis clefts associated with hypotony in two patients. There were no significant adverse events as a result of using this technique. Conclusion The novel technique described increases the likelihood of successful and permanent repair of cyclodialysis clefts with resolution of symptoms associated with hypotony, through direct intraoperative visualization of the cleft. Clinical significance Gonioscopically guided nonpenetrating cyclodialysis cleft repair offers significant benefits over previously described techniques. Advantages of our technique include gonioscopic cleft visualization, enabling accurate localization of the area requiring repair, and subsequent confirmation of adequate closure of the cleft. Using a partial-thickness scleral flap is also less invasive and reduces risks associated with treatment of this potentially challenging complication of ocular trauma. How to cite this article Rodrigues IAS, Shah B, Goyal S, Lim S. Gonioscopically Guided Nonpenetrating Cyclodialysis Cleft Repair: A Novel Surgical Technique. J Curr Glaucoma Pract 2017

  14. Neutropenic enterocolitis: A continuing medical and surgical challenge

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    Norman Oneil Machado

    2010-01-01

    Full Text Available Aim: Neutropenic enterocolitis is a life threatening complication occurring most frequently after intensive chemotherapy in acute leukemia and solid tumors. This review aims to explore the pathogenesis of the condition and appraise the option and outcome of conservative and surgical management based on the literature review. Material and Methods: A Medline search was carried out and most of the relevant papers in English literature from 1973 onwards on neutropenic enterocolitis were reviewed . Results : Twelve reports of single cases, 21 reports of 2 to 4 cases and 15 reports of 5 or more cases were identified. There were no prospective trials or case control studies on therapy of neutropenic enterocolitis. Among the total of 329 cases identified 69% were treated medically and 31% required surgical intervention . Even though a formal comparison of these 2 groups will not be appropriate, the mortality rate of 31% in the medically managed group was higher than those that required surgical intervention (23% . Conclusion: With the increasing use of multiple, new and aggressive chemotherapy for hematological and solid tumors there may be an increased frequency of neutropenic enterocolitis encountered in clinical practice. Clinicians should be acutely aware of the association of neutropenic enterocolitis with chemotherapy for the outcome would depend significantly on an early and appropriate treatment either conservative or surgical .

  15. SURGICAL TREATMENT OF TETRALOGY OF FALLOT IN CHILDREN:A REPORT OF NO SURGICAL DEATH IN 115 CONSECUTIVE CASES

    Institute of Scientific and Technical Information of China (English)

    刘锦纷; 朱宏斌; 朱德明; 陈玲; 苏肇伉; 丁文祥

    2001-01-01

    Objective A surgical team has performed total correction of Tetralogy of Fallot ( TF) consecutively in 115 patients without surgical death. This paper presents an investigation of how to improve the surgical outcome. Methods This group included 115 children, the ages of these children at operation were from 9 months to 13 years(4.6 ± 2.7 years), 47.8% of whom were younger than 3 years old. Associated anomalies included atresia of main pulmonary artery or unilateral pulmonary artery in 4 cases, atrial septal defect ( ASD ) and patent ductus arteriosus ( PDA ) in 11 cases. All patients have undergone total correction. Ventricular septal defects were closed with Dacron patches. Autologous-pericardial patches were used to enlarge the right ventricular outflow tract and pulmonary arteries. 102 cases (89%) needed transannular patches. Results There was no surgical death and the patients have been followed up for 2 months to 4 years. One child died of cardiac arrhythmia 3 months after operation. The remaining patients recovered well. Conclusion The key points in improving the surgical outcome in TF patients lie in the improvement of surgical technique, total elimination of obstruction of right ventricular outflow tract and distal pulmonary arteries. Attention should be paid to the cardiopulmonary bypass and the postoperative care should also be emphasized.

  16. Mohs Surgical Reconstruction Educational Activity: a resident education tool

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    Croley, Julie A; Malone, C Helen; Goodwin, Brandon P; Phillips, Linda G; Cole, Eric L; Wagner, Richard F

    2017-01-01

    Background Surgical reconstructive planning following Mohs surgery can be a difficult subject for dermatology residents to master. Prior research demonstrates that active learning is preferred and more effective compared to passive learning models and that dermatology residents desire greater complexity and volume in surgical training. We present a novel, active, problem-based learning tool for the education of Mohs reconstruction with the goal of improving residents’ ability to plan surgical reconstructions. Materials and methods The Mohs Surgical Reconstruction Educational Activity is an active, problem-based learning activity in which residents designed repairs for planned Mohs defects prior to surgery on an iPad application or on a printed photograph. The attending Mohs surgeon reviewed the reconstructive designs, provided feedback, guided discussion, and facilitated insight into additional issues requiring further review. Residents performed or observed the Mohs and reconstructive surgical procedures for respective repairs. Surveys were administered to participants before and after participating in the Mohs Surgical Reconstruction Educational Activity to assess the educational value of the activity. Survey responses were recorded on a 5-point Likert scale. Results Mean participant-reported confidence in flap and graft knowledge, flap and graft planning, and flap and graft performance increased 1.50–2.50 Likert scale points upon completion of the Mohs surgery rotation by residents participating in the educational activity. The observed trend was larger in the dermatology resident subset, with increases of 2.00–3.50 Likert scale points reported for these questions. Mean participant-reported likelihoods of performing flaps and grafts in the future increased 0.25–0.50 Likert scale points among all residents participating in the educational activity and 0.50–1.00 Likert scale points in the dermatology resident subset. All residents participating in the

  17. Mohs Surgical Reconstruction Educational Activity: a resident education tool.

    Science.gov (United States)

    Croley, Julie A; Malone, C Helen; Goodwin, Brandon P; Phillips, Linda G; Cole, Eric L; Wagner, Richard F

    2017-01-01

    Surgical reconstructive planning following Mohs surgery can be a difficult subject for dermatology residents to master. Prior research demonstrates that active learning is preferred and more effective compared to passive learning models and that dermatology residents desire greater complexity and volume in surgical training. We present a novel, active, problem-based learning tool for the education of Mohs reconstruction with the goal of improving residents' ability to plan surgical reconstructions. The Mohs Surgical Reconstruction Educational Activity is an active, problem-based learning activity in which residents designed repairs for planned Mohs defects prior to surgery on an iPad application or on a printed photograph. The attending Mohs surgeon reviewed the reconstructive designs, provided feedback, guided discussion, and facilitated insight into additional issues requiring further review. Residents performed or observed the Mohs and reconstructive surgical procedures for respective repairs. Surveys were administered to participants before and after participating in the Mohs Surgical Reconstruction Educational Activity to assess the educational value of the activity. Survey responses were recorded on a 5-point Likert scale. Mean participant-reported confidence in flap and graft knowledge, flap and graft planning, and flap and graft performance increased 1.50-2.50 Likert scale points upon completion of the Mohs surgery rotation by residents participating in the educational activity. The observed trend was larger in the dermatology resident subset, with increases of 2.00-3.50 Likert scale points reported for these questions. Mean participant-reported likelihoods of performing flaps and grafts in the future increased 0.25-0.50 Likert scale points among all residents participating in the educational activity and 0.50-1.00 Likert scale points in the dermatology resident subset. All residents participating in the educational activity somewhat or completely agreed

  18. Acute-care surgical service: a change in culture.

    Science.gov (United States)

    Parasyn, Andrew D; Truskett, Philip G; Bennett, Michael; Lum, Sharon; Barry, Jennie; Haghighi, Koroush; Crowe, Philip J

    2009-01-01

    The provision of acute surgical care in the public sector is becoming increasingly difficult because of limitation of resources and the unpredictability of access to theatres during the working day. An acute-care surgical service was developed at the Prince of Wales Hospital to provide acute surgery in a more timely and efficient manner. A roster of eight general surgeons provided on-site service from 08.00 to 18.00 hours Monday to Friday and on-call service in after-hours for a 79-week period. An acute-care ward of four beds and an operating theatre were placed under the control of the rostered acute-care surgeon (ACS). At the end of each ACS roster period all patients whose treatment was undefined or incomplete were handed over to the next rostered ACS. Patient data and theatre utilization data were prospectively collected and compared to the preceding 52-week period. Emergency theatre utilization during the day increased from 57 to 69%. There was a 11% reduction in acute-care operating after hours and 26% fewer emergency cases were handled between midnight and 08.00 hours. There was more efficient use of the entire theatre block, suggesting a significant cultural change. Staff satisfaction was high. On-site consultant-driven surgical leadership has provided significant positive change to the provision of acute surgical care in our institution. The paradigm shift in acute surgical care has improved patient and theatre management and stimulated a cultural change of efficiency.

  19. Trichobezoar - A hair-raising surgical emergency

    Directory of Open Access Journals (Sweden)

    Elizabeth Tan

    2017-06-01

    Full Text Available A trichobezoar is a mass of undigested hair in the proximal gastrointestinal tract. It is a rare condition seen in young females with psychiatric disorders of trichotillomania and trichophagia or mental retardation. We present a case of an intellectually impaired 14-year-old girl with a gastric trichobezoar discovered during an emergency laparotomy. We will discuss the limited but salient findings on history and examination. Through a review of the literature, imaging modalities and treatment options for the early versus late stage of trichobezoar presentations will be identified. Through our case, subsequent holistic management will also be highlighted to prevent recurrence.

  20. Modified technique of endocapsular lens aspiration for severely subluxated lenses.

    Science.gov (United States)

    Khokhar, S; Aron, N; Yadav, N; Pillay, G; Agarwal, E

    2017-08-11

    PurposeSeverely subluxated crystalline lenses pose a difficult situation to anterior segment surgeons and can only be managed surgically by removal of the lens as well as the capsular bag. Several techniques have been described in literature for the management of such cases. We describe a modified technique of endocapsular lens aspiration by the limbal route for lens extraction through small incisions on the cornea.Patients and methodsThirty-two eyes of 16 consecutive patients with severely subluxated crystalline lenses were recruited in the study. All eyes underwent a modified technique of lens aspiration within the capsular bag using a single instrument, vitrectomy cutter, and irrigation cannula, followed by sacrificing of the capsular bag. The patients were either left aphakic or implanted with an open loop anterior chamber intraocular lens (ACIOL Kelman Multiflex) and prospectively followed up for a period of 3 months.ResultsThe mean age of the patients was 9 years 3 months±3 years (range 5-15 yrs). All eyes underwent complete lens aspiration within the capsular bag with no dislocation of the lens matter. ACIOL was inserted in 22 eyes (68.7%) and 10 eyes (31.2%) were left aphakic. All the surgeries were uneventful. The mean best corrected visual acuity (BCVA) at 3 months post surgery was 0.47±0.11 logMAR which was significantly better than pre-operative BCVA (P=0.001). The percentage endothelial cell loss at 3 months was 7.1%. There was no evidence of glaucoma, corneal decompensation, or retinal detachment. The astigmatism which increased from 1.45D±086 preoperatively to 3.76D±2.02 1 week post-operatively due to sutures reduced to 1.97D±0.81 post suture removal at 3 months.ConclusionThe modified technique of endocapsular lens aspiration proves to be a simple and effective method of removal of the lens-capsular bag complex in severely subluxated lenses.Eye advance online publication, 11 August 2017; doi:10.1038/eye.2017.160.