DERMATOLOGIC SURGERY, Issue 3 2006
Preliminary Report of 20 Cases with 6- to 12-Month Follow-Up
BACKGROUND Various suspension suture techniques exist to elevate the mid-face, jowls, and neck. OBJECTIVE To assess safety and efficacy of a new suspension suture and inserting instrument with both standard and minimal incision (no-skin-excision) face-lifts. METHODS A new type of multianchor suspension suture assembled from commercially available 2-0 absorbable monofilament material, with 5 to 9 equally spaced knots through which are secured 7 to 9 mm bits of 0 thickness similar suture material, and an attached straightened needle, was used to elevate and suspend facial tissues to temporal or mastoid fascia. The suspension sutures are placed in the deep subcutaneous tissues, just above the superficial musculo aponeurotic system (SMAS), by use of a novel, blunt instrument, which does not require a second, distal exit point. The suspension suture distal end floats free. The proximal needle end is sutured to fascia. The suture was used on 20 patients. Fourteen of them underwent pure, "no-skin-excision," suspension lifts. Six had suspension suture elevation of the mid-face in conjunction with relatively conservative open lifts. Nine- to 12-month results were evaluated. RESULTS With open face-lifts, 9- to 12-month results are excellent with significant persistence of the correction initially achieved. Resulting scars remained fine line. There were no complications. With pure suspension lifts, initial results were impressive. By 6 months, correction started to fade. By 12 months 100% of initial correction for jowls, and 80 to 100% for mid-face, appeared lost. Recovery time was 2 to 4 days. There were no significant complications. CONCLUSION Large multianchor, absorbable monofilament sutures can safely and effectively enhance results of conservative lifts, with remarkable elevation of the mid-face not achievable with simple SMAS flaps. These suspension sutures can easily and safely achieve impressive, though relatively short-term results, with a minimal incision, "no-skin-excision" technique. [source]

Blood-borne virus prevalence and risk among steroid injectors: Results from the Australian Needle and Syringe Program Survey

DRUG AND ALCOHOL REVIEW, Issue 5 2008
CAROLYN A. DAY PhD
No abstract is available for this article. [source]

Harm reduction programmes in the Asia,Pacific Region

DRUG AND ALCOHOL REVIEW, Issue 1 2008
GARY REID MPH
Abstract Introduction and Aims. This paper reports on the public health intervention of harm reduction to address drug use issues in the Asia , Pacific region. Design and Methods. It is based on the report ,Situational analysis of illicit drug issues and responses in Asia and the Pacific', commissioned by the Australian National Council on Drugs Asia Pacific Drug Issues Committee. A comprehensive desk-based review based on published and unpublished literature and key informant data. Results. Drug use in the Asia , Pacific region is widespread, resulting in serious adverse health consequences. Needle and syringe programmes are found in some parts of Asia, but not in the six Pacific Island countries reviewed. Outreach and peer education programmes are implemented, but overall appear minor in size and scope. Substitution therapy programmes appear to be entering a new era of acceptance in some parts of Asia. Primary health care specifically for drug users overall is limited. Discussion and Conclusions. Harm reduction programmes in the Asia , Pacific region are either small in scale or do not exist. Most programmes lack the technical capacity, human resources and a limited scope of operations to respond effectively to the needs of drug users. Governments in this region should be encouraged to endorse evidence-based harm reduction programmes. [source]

The "Swimmer's View" as Alternative When Lateral View Is Inadequate During Interlaminar Cervical Epidural Steroid Injections

PAIN MEDICINE, Issue 5 2010
Arjang Abbasi DO
Abstract Objective., To present a technique that better visualizes the needle during interlaminar cervical epidural steroid injection (ICESI) in patients where the lateral view is inadequate. Design., Case report. Setting., Private group practice. Subject., A 57-year-old morbidly obese male presenting for ICESI for left neck and upper limb pain after a motor vehicle accident. Magnetic resonance imaging revealed left C6-7 herniated nucleus pulposis and C4-5 osteophytic disc-ridge complex. Electrodiagnostic evaluation revealed activity consistent with a left C7 radiculopathy. Intervention., Left C7-T1 ICESI. Needle was obscured in the lateral view by the patient's shoulders. Needle was made visible by positioning the patient for Swimmer's view. Results., Full resolution of symptoms without associated complications. Conclusions., Grave complications have been associated with ICESI necessitating impeccable and systematic technique with substantial knowledge of anatomy. Although injection at lower levels is advocated for safety concerns, the needle during lateral view may be obscured by the shoulders in some patients. The "Swimmer's View" position may be attempted when lateral view is insufficient to visualize needle during ICESI. [source]

Retained Suture Needle After Tonsillectomy

THE LARYNGOSCOPE, Issue S3 2010
Sherry Fishkin MD
No abstract is available for this article. [source]

Pterygopalatine Fossa Infiltration Through the Greater Palatine Foramen: Where to Bend the Needle

THE LARYNGOSCOPE, Issue 7 2006
FRACP, FRACS, Richard Douglas MD
Abstract Objective: In the literature, there has been controversy regarding the length of the greater palatine canal. If the pterygopalatine fossa is infiltrated in an attempt to reduce bleeding during sinus surgery, this information is important to be able to place local anesthetic with maximal effect and the least likelihood of complications. Study Design: The authors conducted a prospective cadaver-based study using high-definition computed tomography (CT) scans. Methods: Twenty-two cadaver heads were CT scanned and the greater palatine canal length, pterygopalatine fossa height, and thickness of the soft tissue in the roof of the mouth were measured on parasagittal images using the CT scanner workstation. Results: The mean length of the greater palatine canal was 18.5 mm (95% confidence interval [CI] = 17.9,19.1) and the mean height of the pterygopalatine fossa was 21.6 mm (95% CI = 20.7,22.5). The mean thickness of the soft tissue in the roof of the mouth overlying the foramen of the greater palatine canal was 6.9 mm (95% CI = 6.2,7.6). Conclusion: To perform an effective infiltration of the pterygopalatine fossa, the needle should be bent at 25 mm from the tip at an angle of 45°. [source]

Transcutaneous Chordal Injection with a Curved Needle

THE LARYNGOSCOPE, Issue 12 2003
Nobuhiko Isshiki MD
No abstract is available for this article. [source]

Eye of the Needle

AMERICAN JOURNAL OF TRANSPLANTATION, Issue 2 2007
R. B. Colvin
At present, protocol biopsies offer potential for early detection of pathologic processes in the graft, but like any test their predictive value must be established and validated. See also article by Mengel et al in this issue on page 356. [source]

Experimental Study of a New Method for Early Detection of Vascular Access Stenoses: Pulse Pressure Analysis at Hemodialysis Needle

ARTIFICIAL ORGANS, Issue 2 2010
Koen Van Canneyt
Abstract Hemodialysis vascular access (VA) stenosis remains a frequent complication. However, early detection is challenging and costly. The aim of this in vitro study was to assess a new detection method based on pulse pressure analysis at the hemodialysis needle. A silicon model of a radiocephalic arteriovenous fistula was built in a mock loop. Pressure profiles were measured at the arterial hemodialysis needle and in the proximal feeding artery. Stenoses (50 and 25% diameter reduction) were created proximal to the anastomosis (proximal artery) and distal to the arterial needle (distal vein and proximal vein). The pulse pressure (PP) at the needle was divided by the PP at the feeding artery to obtain a dimensionless ratio, %PP. Experiments were conducted at different blood flow (500,1200 mL/min) and heart rates (60,90 beats/min) to test this new index over a wide range of hemodynamic conditions. In the control model (no stenosis), %PP was 20.26 ± 4.55. A proximal artery 50% stenosis significantly decreased %PP to 7.69 ± 2.08 (P < 0.0001), while the presence of 50% stenosis in the distal (36.20 ± 2.12) and proximal (32.38 ± 2.17) vein led to significantly higher values of %PP (P < 0.0001). For stenosis of 25% diameter reduction in the proximal artery, the %PP decreased to 15.45 ± 2.13 (P = 0.0022) and the %PP increased with a 25% stenosis in the distal vein to 26.71 ± 3.01 (P = 0.0003) and in the proximal vein to 26.53 ± 2.67 (P = 0.0004). This in vitro study shows that the analysis of the PP at the dialysis needle is useful for early detection and localization of hemodialysis VA stenosis, independent of heart rate and flow level. [source]

Pacemaker Lead Extraction with the Needle's Eye Snare for Countertraction via a Femoral Approach

PACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 7 2002
DIDIER KLUG
KLUG, D., et al.: Pacemaker Lead Extraction with the Needle's Eye Snare for Countertraction via a Femoral Approach. Femoral approach pacemaker lead extraction is described as a safe and efficacious procedure. When the lead can not be removed from its myocardial insertion, the "Needle's eye snare" has become available, and it allows a femoral approach traction associated with a countertraction . Between May 1998 and May 2000, 222 lead extraction procedures were performed in 99 patients using the femoral approach. This article reports the results of the 70 lead extractions requiring the use of the Needle's eye snare for femoral approach countertraction in 39 patients with a total of 82 leads. The indications were infection, accufix leads and lead dysfunction in 56, 1 and 6 leads, respectively. The age of the leads was 113 ± 56 months. Sixty-one (87.2%) leads were successfully extracted, the extraction was incomplete in 3 (4.3%) cases and failed in 6 (8.5%) cases. The failures were due to leads totally excluded from the venous flow for four leads, the impossibility of advancing the 16 Fr long sheath through the right and left iliac veins for one lead and one traction induced a nontolerated ventricular arrhythmia. In these cases, an extraction by a simple upper traction had been attempted in another center several months before. The complications included two deaths and one transient ischemia of the right inferior limb. Despite the selection of a series of leads for which an extraction by a simple traction on the proximal end of the lead was impossible or unsuccessful, femoral countertraction seems to be a safe and efficacious procedure. The failure of this technique occurred in patients with damaged leads due to a previous extraction procedure performed in centers with limited experience in lead extraction. [source]

The role of olfactory stimuli in the location of weakened hosts by twig-infesting Pityophthorus spp.

ECOLOGICAL ENTOMOLOGY, Issue 1 2001
Pierluigi Bonello
Summary 1. Senescing, shade-suppressed, or broken branches of Monterey pine Pinus radiata are infested by twig beetles in the genus Pityophthorus (Coleoptera: Scolytidae). The studies reported here tested whether twig beetles can discriminate between healthy and pitch canker-diseased branches, whether diseased branch tips produce more ethylene than undamaged controls, and whether ethylene and other volatiles, produced by the plant in response to tissue damage, are utilised by twig beetles in host location. 2. Significantly greater numbers of twig beetles were reared from pitch canker-symptomatic than from pitch canker-asymptomatic branches of Monterey pine collected in the field. 3. Needles of Monterey pine branches inoculated with the pitch canker fungal pathogen Fusarium circinatum produced significantly higher levels of ethylene than needles of control branches, and this was evident just prior to, and during, symptom expression. 4. In trapping studies in which pheromone production was prevented, there was no evidence of attraction of twig beetles to a source of ethylene alone, to cut host branches, or to cut branches treated with the ethylene-releasing compound, ethephon. The results suggest that twig beetles identify weakened branches after landing. [source]

John Gay, Magnetism and the Spectacle of Natural Philosophy: Scriblerian Pins and Needles

JOURNAL FOR EIGHTEENTH-CENTURY STUDIES, Issue 3 2007
Gregory Lynall
First page of article [source]

Energy Dissipation and Photoinhibition in Douglas-Fir Needles with a Fungal-Mediated Reduction in Photosynthetic Rates

JOURNAL OF PHYTOPATHOLOGY, Issue 11-12 2002
Daniel K. Manter
Abstract The dissipation of absorbed light and potential for photooxidative damage was explored in Douglas-fir (Pseudotsuga menziesii ) seedlings with and without Phaeocryptopus gaeumannii infection. The presence of P. gaeumannii significantly reduced net CO2 assimilation rates from ca. 6 ,mol/m2/s to 1.5 ,mol/m2/s, without any significant impact on chloroplast pigments. The partitioning of absorbed light-energy to photochemistry or thermal dissipation was determined from chlorophyll fluorescence measurements. Maximum thermal dissipation for both control and infected needles was ca. 80%, consistent with the similar xanthophyll pool sizes in the two treatments. At high photosynthetic photon flux density (PPFD), when thermal dissipation was maximized, the lower photochemical utilization in infected needles resulted in greater amounts of excess absorbed light (ca. 20 and 10% for the infected and control needles, respectively). A second experiment, monitoring changes in photosystem II (PSII) efficiency (Fv/Fm) in response to a 1 h high light treatment (PPFD=2000 ,mol/m2/s) also suggests that infected needles absorb greater amounts of excess light. In this experiment, declines in Fv/Fm were 1.5 times greater in infected needles, despite the similar xanthophyll pool sizes. Furthermore, increases in minimum fluorescence (178 and 122% of initial values for the infected and control needles, respectively) suggest that the reduction in PSII efficiency is largely attributable to photooxidative damage. Finally, reductions in PSII efficiency under high light conditions provide a plausible explanation for the greater pathogenicity (e.g. premature needle abscission) of P. gaeumannii in sun-exposed foliage. [source]

The XMM,Newton Needles in the Haystack Survey: the local X-ray luminosity function of ,normal' galaxies

MONTHLY NOTICES OF THE ROYAL ASTRONOMICAL SOCIETY, Issue 2 2005
I. Georgantopoulos
ABSTRACT In this paper we estimate the local (z < 0.22) X-ray luminosity function of ,normal' galaxies derived from the XMM,Newton Needles in the Haystack Survey. This is an on-going project that aims to identify X-ray-selected normal galaxies (i.e. non-AGN dominated) in the local Universe. We are using a total of 70 XMM,Newton fields covering an area of 11 deg2 which overlap with the Sloan Digital Sky Survey Data Release 2. Normal galaxies are selected on the basis of their resolved optical light profile, their low X-ray-to-optical flux ratio [log (fx/fo) < , 2] and soft X-ray colours. We find a total of 28 candidate normal galaxies to the 0.5,8 keV band flux limit of ,2 × 10,15 erg cm,2 s,1. Optical spectra are available for most sources in our sample (82 per cent). These provide additional evidence that our sources are bona fide normal galaxies with X-ray emission coming from diffuse hot gas emission and/or X-ray binaries rather than a supermassive black hole. 16 of our galaxies have narrow emission lines or a late-type spectral energy distribution (SED) while the remaining 12 present only absorption lines or an early-type SED. Combining our XMM,Newton sample with 18 local (z < 0.22) galaxies from the Chandra Deep Field North and South surveys, we construct the local X-ray luminosity function of normal galaxies. This can be represented with a Schechter form with a break at L,, 3+1.4,1.0× 1041 erg s,1 and a slope of ,, 1.78 ± 0.12. Using this luminosity function and assuming pure luminosity evolution of the form ,(1 +z)3.3 we estimate a contribution to the X-ray background from normal galaxies of ,10,20 per cent (0.5,8 keV). Finally, we derive, for the first time, the luminosity functions for early- and late-type systems separately. [source]

Needles, Herbs, Gods, and Ghosts: China, Healing, and the West to 1848 by Linda L. Barnes

AMERICAN ETHNOLOGIST, Issue 4 2009
C. PIERCE SALGUERO
No abstract is available for this article. [source]

EPIDUROGRAPHY: CHARACTERISTICS OF EPIDURALGRAMS PERFORMED DURING LESI

PAIN MEDICINE, Issue 2 2002
Article first published online: 4 JUL 200
David C. Miller MD, DABPM Woodland Pain Center, Michigan City, IN Fluoroscopically guided, contrast enhanced lumbar epidural steroid injections are commonly performed for persistent or sever lumbar radicular pain. An epiduralgram is a real-time fluoroscopic image of contrast injected into the epidural space prior to the injection of local anesthetic and steroid. This report details the results of one hundred consecutive epiduralgrams. The epidural needle was placed under continuous multiplainer fluoroscopic guidance using ISIS protocol. Three ml. of Omnipaque 300 were injected after initial insertion to obtain the epiduralgram. This was followed by injection of 3 ml. of Celestone diluted with 4 ml. of preservative-free 1% lidocaine to obtain the epiduralgram. The epidural needle was placed at the predetermined spinal level and appropriate side 100% of the time. Needles were successfully placed into the epidural space on the first attempt in 95%. One needle was subarachnoid, one was intra vascular, three were in tissue plains superficial to the epidural space and were apparent only with contrast injection. Three ml. of contrast flowed unilaterally in 74% of lumbar epidural injections. The contrast flowed cephalad only in 20%, caudad only in 28%, and bidirectional in 52%. Contrast spread less than three spinal levels 64% of the time. The desired nerve root was visualized in 62%. Contrast was seen in the ventral epidural space on lateral views 88% of the time. Ventral spread was always fewer levels than the dorsal spread. Epidurography provides essential information for the accurate performance of lumbar epidural steroid injections. One out of every twenty presumed epidural injections were inaccurately placed even by an experienced operator. One out of every fifty was dangerously positioned and identified only by performance of an epiduralgram. [source]

Epidermal transpiration, ultrastructural characteristics and net photosynthesis of white spruce somatic seedlings in response to in vitro acclimatization

PHYSIOLOGIA PLANTARUM, Issue 4 2003
Mohammed S. Lamhamedi
Mortality of transplanted somatic seedlings at the stage of acclimatization is often high and likely due to rapid change in environmental conditions. To investigate the potential of in vitro acclimatization of somatic seedlings before soil transfer, somatic seedlings of white spruce (Picea glauca[Moench] Voss) were germinated on a liquid medium supplemented with sucrose. After 6 weeks in germination, sucrose was omitted from the medium for a supplementary 6 weeks at which time somatic seedlings were acclimatized in vitro in their germination tubes before transfer to soil. In vitro acclimatization of somatic seedlings was realized by transferring the test tubes containing the germinated somatic seedlings to the greenhouse for 9 days. During this period, the culture tube lids of acclimatized somatic seedlings were lifted progressively increasing air exchange between the tube and the greenhouse whereas, for non-acclimatized somatic seedlings the culture tubes were maintained closed during in vitro acclimatization. In vitro acclimatized somatic seedlings had higher asymptotic net photosynthesis (Pn) at light saturation than non-acclimatized seedlings (6 versus 4.5 µmol m,2 s,1). At the end of the in vitro acclimatization period, a lower rate of epidermal transpiration was also observed for acclimatized somatic seedlings (3.85 versus 4.75% h,1). Microscopic observations showed that starch granules were more abundant in needles of acclimatized somatic seedlings than in non-acclimatized somatic seedlings, probably as a result of their greater photosynthetic capacity. Needles from acclimatized somatic seedlings also showed more epicuticular wax projections than needles from non-acclimatized somatic seedlings. These structural changes may help somatic seedlings to restrict epidermal water loss and stomatal aperture. [source]

Needle cytokinin content as a sensitive bioindicator of N pollution in Sitka spruce

PLANT CELL & ENVIRONMENT, Issue 12 2003
M. D. COLLIER
ABSTRACT Previous work has shown that conifers growing on sites exposed to aerial pollution exhibit a different pattern of vegetative development in comparison with those on unpolluted sites, and have higher needle cytokinin contents (von Schwartzenberg & Hahn, Journal of Plant Physiology 139, 218,223, 1991). Physiologically mature Sitka spruce (Picea sitchensis[Bong.] Carr) trees growing in a commercial plantation were sprayed with combinations of S, N and acidity from bud burst until December, for a 3 year period, in order to factor out the effects of individual pollutants and identify the specific component responsible for the high cytokinin content. Cytokinins were monitored using high-performance liquid chromatography/enzyme-linked immunosorbent assay techniques. After 3 years of treatment only needles of neutral N-treated trees contained significantly higher levels of cytokinin than those of trees receiving no spray. The addition of acid S could suppress the effects of added N. Needles from neutral N treatments also contained significantly higher levels of biologically active cytokinins and forms that can be transported in the xylem/phloem. Significantly lower levels of active cytokinins were present in needles sprayed with N in combination with acid sulphate. The results demonstrate that the needle cytokinin content may be used as a sensitive and selective bioindicator of the early stages in N perturbation in coniferous trees. [source]

Finding Some Needles in the Haystack: Textbook Publishing on the Subjects of GIS and Spatial Data Analysis

THE CANADIAN GEOGRAPHER/LE GEOGRAPHE CANADIEN, Issue 1 2010
RON N. BULIUNG
First page of article [source]

EDITORIAL: Birth of Online Early for The Journal of Sexual Medicine: From Pins and Needles to Pregnant Pause; Reflections on Premature Ejaculation and Persistent Sexual Arousal Syndrome

THE JOURNAL OF SEXUAL MEDICINE, Issue 3 2005
Irwin Goldstein MD Editor-in-chief
[source]

First Three Examples of Taxane-Derived Di-propellanes in Taxus canadensis Needles.

CHEMINFORM, Issue 29 2004
Qing Wen Shi
Abstract For Abstract see ChemInform Abstract in Full Text. [source]

Photosynthesis and Photoprotection in Overwintering Plants

PLANT BIOLOGY, Issue 5 2002
W. W. Adams III
Abstract: Seasonal differences in the capacity of photosynthetic electron transport, leaf pigment composition, xanthophyll cycle characteristics and chlorophyll fluorescence emission were investigated in two biennial mesophytes (Malva neglecta and Verbascum thapsus) that grow in full sunlight, and in leaves/needles of sun and shade populations of several broad-leafed evergreens and conifers (Vinca minor, Euonymus kiautschovicus, Mahonia repens, Pseudotsuga menziesii [Douglas fir], and Pinus ponderosa). Both mesophytic species maintained or upregulated photosynthetic capacity in the winter and exhibited no upregulation of photoprotection. In contrast, photosynthetic capacity was downregulated in sun leaves/needles of V. minor, Douglas fir, and Ponderosa pine, and even in shade needles of Douglas fir. Interestingly, photosynthetic capacity was upregulated during the winter in shade leaves/needles of V. minor, Ponderosa pine and Euonymus kiautschovicus. Nocturnal retention of zeaxanthin and antheraxanthin, and their sustained engagement in a state primed for energy dissipation, were observed largely in the leaves/needles of sun-exposed evergreen species during winter. Factors that may contribute to these differing responses to winter stress, including chloroplast redox state, the relative levels of source and sink activity at the whole plant level, and apoplastic versus symplastic phloem loading, are discussed. [source]

An augmented reality system to guide radio-frequency tumour ablation

COMPUTER ANIMATION AND VIRTUAL WORLDS (PREV: JNL OF VISUALISATION & COMPUTER ANIMATION), Issue 1 2005
S. Nicolau
Abstract Radio-frequency ablation is a difficult operative task that requires a precise needle positioning in the centre of the pathology. This article presents an augmented reality system for hepatic therapy guidance that superimposes in real-time 3D reconstructions (from CT acquisition) and a virtual model of the needle on external views of a patient. The superimposition of reconstructed models is performed with a 3D/2D registration based on radio-opaque markers stuck on to the patient's skin. The characteristics of the problem (accuracy, robustness and time processing) led us to develop automatic procedures to extract and match the markers and to track the needle in real time. Experimental studies confirmed that our algorithms are robust and reliable. Preliminary experiments conducted on a human abdomen phantom showed that our system is highly accurate (needle positioning error within 3,mm) and enables the surgeon to reach a target in less than 1 minute on average. Our next step will be to perform an in vivo evaluation. Copyright © 2005 John Wiley & Sons, Ltd. [source]

Transbronchial fine needle aspiration cytology in the diagnosis of mediastinal/hilar sarcoidosis

CYTOPATHOLOGY, Issue 1 2007
S. Smojver-Je
Objective:, The diagnostic value of transbronchial/transtracheal fine needle aspiration (TBFNA) cytology in the patients with mediastinal and/or hilar lymphadenopathy has been investigated. Method:, Out of 116 patients with mediastinal/hilar lymphadenopathy, the diagnosis of sarcoidosis was established in 88 (75.9%). One hundred and seventy-one TBFNAs from different lymph node stations were performed using a cytological 26-gauge needle. Adequate lymph node samples were obtained in 157 of 171 (91.8%) TBFNA and 14 of 171 (8.2%) TBFNA samples were inadequate. Results:, Cytological findings consistent with sarcoidosis were found in 79 of 88 (89.77%) patients and 133 of 157 (84.71%) samples. The sensitivity of TBFNA cytology in sarcoidosis presenting as mediastinal/hilar lymphadenopathy was 78.7%, specificity 92.3%. Conclusions:, Overall diagnostic accuracy of TBFNA cytology in the diagnosis of sarcoidosis was 86.2%, and cytological findings consistent with sarcoidosis were the only morphological diagnosis of sarcoidosis in 63.6% of patients. [source]

NON-GYNAECOLOGICAL CYTOLOGY: THE CLINICIAN'S VIEW

CYTOPATHOLOGY, Issue 2006
I. Penman
There is increased recognition of the importance of accurate staging of malignancies of the GI tract and lung, greater use of neoadjuvant therapies and more protocol-driven management. This is particularly important where regional lymph node involvement significantly impacts on curability. Multidetector CT and PET scanning have resulted in greater detection of potential abnormalities which, if positive for malignancy, would change management. There is also a greater recognition that many enlarged nodes may be inflammatory and that size criteria alone are unreliable in determining involvement. In other situations, especially pancreatic masses, not all represent carcinoma as focal chronic pancreatitis, autoimmune pancreatitis etc can catch out the unwary. A preoperative tissue diagnosis is essential and even if unresectable, oncologists are increasingly reluctant to initiate chemotherapy or enroll patients into trials without this. The approach to obtaining tissue is often hampered by the small size or relative inaccessibility of lesions by percutaneous approaches. As such novel techniques such as endoscopic ultrasound (EUS) guided FNA have been developed. A 120cm needle is passed through the instrument and, under real-time visualisation, through the gastrointestinal wall to sample adjacent lymph nodes or masses. Multiple studies have demonstrated the safety and performance of this technique. In oesophageal cancer, confirmation of node positivity by has a major negative influence on curative resection rates and will often lead to a decision to use neoadjuvant chemotherapy or a non-operative approach. Sampling of lymph nodes at the true coeliac axis upstages the patient to M1a status (stage IV) disease and makes the patient incurable. In NSCLC, subcarinal lymph nodes are frequently present but may be inflammatory. If positive these represent N2 (stage IIIA) disease and in most centres again makes the patient inoperable. Access to these lymph nodes would otherwise require mediastinosocopy whereas this can be done simply, safely and quickly by EUS. Overall the sensitivity for EUS , FNA of mediastinal or upper abdominal lymph nodes is 83,90% with an accuracy of 80,90%. In pancreatic cancer performance is less good but pooled analysis of published studies indicates a sensitivity of 85% and accuracy of 88%. In a recent spin-off from EUS, endobronchial ultrasound (EBUS) instruments have been developed and the ability to sample anterior mediastinal nodes has been demonstrated. It is likely that this EBUS , FNA technique will become increasingly utilised and may replace mediastinoscopy. The development of techniques such as EUS and EBUS to allow FNA sampling of lesions has increased the role of non-gynaecological cytology significantly in recent years. Cytology therefore remains important for a broad range of specialties and there is ongoing need for careful and close co-operation between cytologists and clinicians in these specialties. References:, 1. Williams DB, Sahai AV, Aabakken L, Penman ID, van Velse A, Webb J et al. Endoscopic ultrasound guided fine needle aspiration biopsy: a large single centre experience. Gut. 1999; 44: 720,6. 2. Silvestri GA, Hoffman BJ, Bhutani MS et al. Endoscopic ultrasound with fine-needle aspiration in the diagnosis and staging of lung cancer. Ann Thorac Surg 1996; 61: 1441,6. 3. Rintoul RC, Skwarski KM, Murchison JT, Wallace WA, Walker WS, Penman ID. Endobronchial and endoscopic ultrasound real-time fine-needle aspiration staging of the mediastinum ). Eur Resp J 2005; 25: 1,6. [source]

Fine needle aspiration cytology in the diagnosis of bone lesions

CYTOPATHOLOGY, Issue 2 2005
U. Handa
Objective:, Fine needle aspiration cytology (FNAC) in combination with radiological examination has recently gained clinical recognition for evaluating skeletal lesions. We evaluated our experience with the use of FNA in diagnosing bone lesions with emphasis on areas of difficulty and limitations. Materials and Methods:, Over a period of 5 years FNA was performed in 66 cases of bone lesions. Aspirations were done by cytopathologists using 22-gauge needle. Out of 66 cases unsatisfactory aspirate was obtained in 12 cases. Cytohistological correlation was available in 19 cases. Results:, Adequate aspirates were categorized into neoplastic (27 cases) and non-neoplastic (27 cases) lesions. Of the 27neoplastic aspirates, 20 were malignant (12 primary, 8 metastatic deposits) and 7 were benign. In the malignant group osteosarcoma was correctly diagnosed in 3 cases while other 3 were labeled as sarcoma NOS because of lack of osteoid. Metastatic deposits were sub-typed in 6 cases; from renal cell carcinoma (3 cases), proststic adenocarcinoma, follicular carcinoma thyroid, and squamous cell carcinoma. Neoplastic group comprised of 6 cases of cysts and 21 cases of chronic osteomyelitis. Thirteen cases were diagnosed as tuberculous osteomyelitis. Conclusions:, FNA is a frequent indication in metastases in the bone where distinct cytologic features can even identify an unknown primary. However, diagnosis of primary tumours of the bone is limited by precise subtyping of the tumours. FNA has emerged as a cost effective tool for initial diagnosis of both neoplastic and non-neoplastic lesions of the bone. [source]

A 52-Month Summary of Results Using Calcium Hydroxylapatite for Facial Soft Tissue Augmentation

DERMATOLOGIC SURGERY, Issue 2008
THOMAS L. TZIKAS MD
OBJECTIVES In this large-scale clinical review, we investigated the safety and efficacy of Radiesse, an injectable calcium hydroxylapatite (CaHA) implant, in treatment of nasolabial folds, marionette lines, and other areas of the face. METHODS After obtaining informed consent from the subjects, CaHA was injected in 1,000 patients (886 women and 114 men, ranging in age from 21 to 85 years) for a variety of facial aesthetic applications over a period of 52 months. Typically, CaHA was administered with a 27-gauge 1/2, or 1 1/4-inch needle. RESULTS The nasolabial folds were the most frequently treated site, followed by the marionette lines/oral commissure. More than 80% of patients reported persistence of results at 12 months. The most frequently reported adverse events were erythema and ecchymosis. The formation of nodules was rare and was chiefly confined to the lips. Only two patients experienced nodule formation outside the lips. CONCLUSIONS Over a period of more than 4 years, we found that CaHA performed well, with a favorable safety profile, high patient satisfaction, and good durability. [source]

A Multicenter, 47-Month Study of Safety and Efficacy of Calcium Hydroxylapatite for Soft Tissue Augmentation of Nasolabial Folds and Other Areas of the Face

DERMATOLOGIC SURGERY, Issue 2007
NEIL S. SADICK MD
OBJECTIVES Each soft tissue filler product has its own unique profile in terms of adverse events. In this large-scale study, we investigated the safety profile of Radiesse, an injectable calcium hydroxylapatite (CaHA) implant, in treatment of nasolabial folds and other areas of the face. We also investigated the efficacy in a subset of the larger patient group. METHODS After obtaining informed consent from the subjects, researchers injected CaHA at two treatment centers into 113 patients (100 women and 13 men, ranging in age from 26 to 78 years) for a variety of facial aesthetic applications over a period of 47 months. Seventy-five patients had a single injection session; 38 had multiple sessions. Most patients (102) received 1.0 mL of CaHA per session; 12 received 2.0 mL per session. Typically, CaHA was administered with a 27-gauge 0.5- or 1 1/4-in. needle. RESULTS Safety. Of 113 patients, only 7 reported minor adverse events that were short-term and resolved within 1 month: transient ecchymosis (3), nongranulatomous submucosal nodules of the lip (2), and inflammation and edema (2). Efficacy. Efficacy ratings were performed for a subset of patients (n=41). On a scale of 1 to 5 (1=unsatisfactory; 5=excellent), the mean patient evaluation score for look and feel of the implant was 4.6; the mean physician scores for the look and feel of the implant were 4.5 and 4.6, respectively. During the 6-month follow-up visit, patients' mean ratings of the look and feel of the implant were 4.8 and 4.9, respectively. The physician's mean ratings for the look and feel of the implant were 4.5 and 4.9, respectively. CONCLUSIONS In our study, CaHA performed well, with a favorable safety profile, high patient satisfaction (90% of patients reported very good or excellent results), and good durability. We are especially pleased with the low incidence of adverse events coupled with the favorable responses from the patients themselves due to longevity of correction. [source]

Novel Face-Lift Suspension Suture and Inserting Instrument: Use of Large Anchors Knotted into a Suture with Attached Needle and Inserting Device Allowing for Single Entry Point Placement of Suspension Suture.

A Percutaneous Approach to Eyebrow Lift: The Salvadorean Option

DERMATOLOGIC SURGERY, Issue 8 2003
Enrique Hernandez-Perez MD
Background Surgical eyebrow lift can result in a number of complications. A nonsurgical simple method of lifting the brow is presented. Objective To raise the eyebrows using a simple, quick, and noninvasive approach. Methods Twenty-nine patients, 27 women and 2 men, whose ages varied from 24 to 56 years (mean of 32 years) were included in the study. Preoperative and postoperative photographs were taken. In two patients, brow suspension was performed at the time of blepharoplasty. Informed consent was signed by all of the patients. For measuring the degree of satisfaction of the patients, we gave to them a sheet grading it from one to three (with one being the least satisfactory). Local anesthesia (1% lidocaine, 1:400,000 epinephrine), a conveniently sized Keith needle, and prolene 3/0 sutures were used. Results Satisfying results were obtained in all cases. The only problem encountered in two patients was temporary edema, and it settled in a few days. Conclusion This is a very simple, quick, and noncomplicated method of raising the eyebrows. It can be repeated, revised easily, or combined with other modalities, such as peels, topical tretinoin, oral isotretinoin, fat injection, Goretex, and Botox as part of a facial rejuvenation program. [source]