Invasive Investigations (invasive + investigation)

Distribution by Scientific Domains

Selected Abstracts

Randomized clinical trial of the effect of needle gauge and local anaesthetic on the pain of breast fine-needle aspiration cytology,

I. R. Daltrey
Background: Breast fine-needle aspiration cytology (FNAC) is an invasive investigation which can be uncomfortable or distressing. This randomized study investigated the discomfort of breast FNAC and the effect of different techniques. Methods: Some 116 FNAC samples were taken from 98 women with a palpable breast mass. Each patient was randomized to one of four study groups; aspiration was performed using a green-hub (21 G) or blue-hub (23 G) needle, either with or without local anaesthetic. Each patient scored the pain of the whole procedure using a visual analogue scale. Results: A green-hub needle caused significantly more discomfort (mean(s.e.m.) pain score 51(04) cm) than a blue-hub needle (29(04) cm), or either a blue- or green-hub needle with local anaesthetic (30(04) and 21(04) cm respectively) (F = 1028, 3112 d.f., P < 001, analysis of variance). Conclusion: The discomfort of breast FNAC is dependent upon the gauge of the needle and the use of local anaesthetic. A blue-hub needle without local anaesthetic should be first choice for breast FNAC. 2000 British Journal of Surgery Society Ltd [source]

Music and its effect on anxiety in short waiting periods: a critical appraisal

Marie Cooke PhD
Aims and objectives., This paper undertakes a critical appraisal of the methodological issues associated with studies that have investigated the extent to which music decreased the anxiety experienced by patients in short-term waiting periods such as day surgery. Background., Investigations and surgery undertaken on a day basis have significantly increased in number over the last decade. Music has been evaluated as an appropriate nursing intervention in relation to pain, discomfort and anxiety in a number of clinical settings but its usefulness for decreasing anxiety in short-term waiting periods such as day surgery is only beginning to be understood. Conclusion., A number of methodological limitations are identified by this critical review, particularly in relation to the design of research studies. Recommendations to strengthen research in this area are suggested and include (i) describing methods clearly and with detail to allow assessment of the validity and rigour of study results; (ii) using permuted block randomization; (iii) recruiting from a variety of surgical procedures and cultural groups; and (iv) standardizing the health care provided during waiting period. Relevance to clinical practice., Music as a simple and cost-effective intervention to reduce the anxiety experienced in limited time periods will have enormous impact on clinical practice where patients wait and undergo invasive investigations, procedures or surgery. However, the evidence of its utility in these unique environments is only beginning to emerge and this critical review provides a basis for considerations for future research. [source]

Roles for Imaging in Understanding the Pathophysiology, Clinical Evaluation, and Management of Patients with Mitochondrial Disease

A. Parry MRCP
ABSTRACT Primary mitochondrial disorders remain uncommon, but they enter into the differential diagnosis for a broad range of syndromes. Functional and structural imaging methods offer important clinical tools for patient assessment when these diseases are suspected. Although the findings are not specific, in the appropriate clinical context, these tests can guide the use of more specific or invasive investigations. They have provided considerable information concerning the underlying pathophysiology of this heterogeneous range of disorders. Monitoring these changes potentially facilitates the identification of new therapies and their individualization. [source]

Does peak systolic velocity correlate with renal artery stenosis in a pediatric renal transplant population?

Anthony Cook
Abstract:, PSV of renal transplant vessels, calculated during allograft ultrasonography, has previously been shown to correlate with TRAS. Controversy exists regarding the threshold PSV value (adult range: 1.5,3.0 ms), which should prompt further, more invasive investigations to confirm the diagnosis of TRAS. Furthermore, there is a paucity of literature regarding PSV values in the pediatric renal transplant population. In a group of pediatric renal transplant patients, we correlated post-operative renal transplant PSV values with BP, renal function (serum creatinine) and TRAS. All patients who underwent cadaveric or living-related renal transplantation at the HSC between 2001 and 2004 with at least 6 months of follow-up were reviewed through the HSC multi-organ transplant database. Post-operative allograft Doppler ultrasonography was performed during routine follow-up. PSV values obtained were correlated with BP and serum creatinine performed concomitantly. Finally, we correlated PSV in those patients who underwent more intensive investigations, including magnetic resonance and conventional angiography. Fifty-three patients underwent transplantation during the study period. Complete data available for 50/53 demonstrated a mean PSV of 2.13 m/s (range: 0.9,6.1 m/s) for all patients. Of six patients who underwent MRA for suspicion of TRAS, two (with mean PSV values of 1.93 m/s) were found to have clinically significant stenoses. Four of six without angiographic evidence of TRAS had mean PSV values of 2.22 m/s. Patients suspected of having TRAS demonstrated elevated median serum creatinine values compared with those without clinical suspicion of TRAS. However, both mean PSV and BP were not found to be statistically different in both patient subgroups. Furthermore, there was no correlation identified between PSV and serum creatinine and BP in these patient populations. Despite the utility of PSV for monitoring adult renal transplant patients, we did not find that PSV correlated with BP, nadir creatinine or identify those patients who, through subsequent investigations, were found to have TRAS in this pediatric population. Maintaining cognizance in conjunction with close clinical follow-up may identify patients at risk for this rare but potentially morbid complication of transplantation. [source]

Reversible brain lesions in childhood hypertension

P Singhi
Posterior leukoencephalopathy syndrome is characterized by an acute, usually reversible, encephalopathy with transient occipital lobe abnormalities detected on MRI that occur mostly in association with acute hypertension. The clinical presentation includes seizures, headache, altered mental status and blindness. Disturbed autoregulation of cerebral blood flow and endothelial injury are central to the pathogenesis of this disorder. Prompt control of hypertension results in rapid and complete neurological recovery. In this report we discuss the cases of two children with acute onset hypertension of different aetiologies that presented with the characteristic features of posterior leukoencephalopathy syndrome. Conclusion: Early recognition of this readily treatable condition may obviate the need for extensive and invasive investigations. Despite the alarming lesions on the MRI, prompt control of hypertension carries a uniformly favourable prognosis. [source]