DERMATOLOGIC SURGERY, Issue 4 2000
Robert C. Langdon MDArticle first published online: 24 DEC 200
Background. Liposuction of the jowl region is difficult from a single submental incision and must be done conservatively in order to avoid overresection of fat. The neck region may be suctioned much more completely. Objective. A new method for liposuction of the neck and jowls that uses five incisions and that combines syringe suctioning of the jowls and machine-assisted suctioning of the neck has been developed. Methods. The neck was suctioned from submental and infra-auricular incisions. The jowls were suctioned from the infra-auricular and additional infrajowl incisions. Results. This method has been used on 68 patients over a 3-year period. Three additional patients underwent syringe liposuction of only the jowls. Volumes of fat aspirated from bilateral jowls were consistently nearly equal. The incidence of adverse events was low. Conclusion. This method enables conservative removal of jowl fat and thorough removal of neck fat, with a low incidence of adverse sequalae. [source]

Intrapancreatic schwannoma diagnosed by endoscopic ultrasound-guided fine-needle aspiration cytology

DIAGNOSTIC CYTOPATHOLOGY, Issue 2 2009
Shaoying Li M.D.
Abstract Schwannoma is a tumor of neuro-ectodermal origin, usually occuring in the head and neck and extremities. A retroperitoneal, and particularly intra-pancreatic presentation is very rare, and poses a clinical and diagnostic challenge. We report a case of a male patient who underwent an Endoscopic Ultrasound-guided Fine Needle Aspiration (EUS-FNA) biopsy of a hypoechoic, intra-pancreatic mass. The onsite cytological evaluation was consistent with a spindle cell neoplasm. Further evaluation, aided by immunohistochemical stains, defined the mass as a Schwannoma. The patient then underwent a pancreaticoduodenectomy and the histopathological diagnosis of the surgical specimen confirmed the cytological diagnosis. To our knowledge, this is the first report of intra-pancreatic Schwannoma diagnosed preoperatively by EUS-FNA cytology. Diagn. Cytopathol. 2009. © 2008 Wiley-Liss, Inc. [source]

Utilization of ancillary studies in thyroid fine needle aspirates: A synopsis of the National Cancer Institute Thyroid Fine Needle Aspiration State of the Science Conference,,

DIAGNOSTIC CYTOPATHOLOGY, Issue 6 2008
Armando C. Filie M.D.
Abstract The National Cancer Institute (NCI) sponsored the NCI Thyroid Fine Needle Aspiration (FNA) State of the Science Conference on October 22,23, 2007 in Bethesda, MD. The 2-day meeting was accompanied by a permanent informational website and several on-line discussion periods between May 1 and December 15, 2007 (http://thyroidfna.cancer.gov). This document summarizes matters regarding the utilization of ancillary studies in thyroid FNA (http://thyroidfna.cancer.gov/pages/info/agenda/). Diagn. Cytopathol. 2008;36:438,441. © 2008 Wiley-Liss, Inc. [source]

Post-thyroid FNA testing and treatment options: A synopsis of the National Cancer Institute Thyroid Fine Needle Aspiration State of the Science Conference,,

DIAGNOSTIC CYTOPATHOLOGY, Issue 6 2008
Lester J. Layfield M.D.
Abstract The National Cancer Institute (NCI) sponsored the NCI Thyroid Fine Needle Aspiration (FNA) State of the Science Conference on October 22,23, 2007 in Bethesda, MD. The 2-day meeting was accompanied by a permanent informational Web site and several on-line discussion periods between May 1 and December 15, 2007 (http://thyroidfna.cancer.gov). This document addresses follow-up procedures and therapeutic options for suggested diagnostic categories. Follow-up options for "nondiagnostic" and "benign" thyroid aspirates are given. The value of ultrasound examination in the follow-up of "nondiagnostic" and "benign" thyroid aspirates is discussed. Ultrasound findings requiring reaspiration or surgical resection are described as are the timing and length of clinical and ultrasonographic surveillance for cytologically "benign" nodules. Options for surgical intervention are given for the diagnostic categories of "atypical/borderline," "follicular neoplasm," "suspicious for malignancy" and "malignant" (http://thyroidfna.cancer.gov/pages/info/agenda/). Diagn. Cytopathol. 2008;36:442,448. © 2008 Wiley-Liss, Inc. [source]

Needle Aspiration of Spontaneous Pneumothorax

ACADEMIC EMERGENCY MEDICINE, Issue 4 2010
Ethan S. Brandler MD
No abstract is available for this article. [source]

Nasogastric Aspiration and Lavage in Emergency Department Patients with Hematochezia or Melena Without Hematemesis

ACADEMIC EMERGENCY MEDICINE, Issue 2 2010
Nicholas Palamidessi MD
Abstract Objectives:, The utility of nasogastric aspiration and lavage in the emergency management of patients with melena or hematochezia without hematemesis is controversial. This evidence-based emergency medicine review evaluates the following question: does nasogastric aspiration and lavage in patients with melena or hematochezia and no hematemesis differentiate an upper from lower source of gastrointestinal (GI) bleeding? Methods:, MEDLINE, EMBASE, the Cochrane Library, and other databases were searched. Studies were selected for inclusion in the review if the authors had performed nasogastric aspiration (with or without lavage) in all patients with hematochezia or melena and performed esophagogastroduodenal endoscopy (EGD) in all patients. Studies were excluded if they enrolled patients with history of esophageal varices or included patients with hematemesis or coffee ground emesis (unless the data for patients without hematemesis or coffee ground emesis could be separated out). The outcome was identifying upper GI hemorrhage (active bleeding or high-risk lesions potentially responsible for hemorrhage) and the rate of complications associated with the nasogastric tube insertion. Quality of the included studies was assessed using standard criteria for diagnostic accuracy studies. Results:, Three retrospective studies met our inclusion and exclusion criteria. The prevalence of an upper GI source for patients with melena or hematochezia without hematemesis was 32% to 74%. According to the included studies, the diagnostic performance of the nasogastric aspiration and lavage for predicting upper GI bleeding is poor. The sensitivity of this test ranged from 42% to 84%, the specificity from 54% to 91%, and negative likelihood ratios from 0.62 to 0.20. Only one study reported the rate complications associated with nasogastric aspiration and lavage (1.6%). Conclusions:, Nasogastric aspiration, with or without lavage, has a low sensitivity and poor negative likelihood ratio, which limits its utility in ruling out an upper GI source of bleeding in patients with melena or hematochezia without hematemesis. ACADEMIC EMERGENCY MEDICINE 2010; 17:126,132 © 2010 by the Society for Academic Emergency Medicine [source]

Pulmonary aspiration of a two-unit bridge during a deep sleep

JOURNAL OF ORAL REHABILITATION, Issue 6 2005
Ö. K. BA
summary, Aspiration of teeth and dental restorations is a recognized, yet an infrequent happening in the literature. Main reasons of aspiration are maxillofacial trauma, dental treatment procedures or ethanol intoxication and dementia. The present case of a 2-unit bridge aspiration is however, not related with any trauma, dental procedure or systemic disease. A 37-year-old male patient had aspirated his bridge while sleeping and the bridge remained unidentified for 1 year despite the radiographic controls. He was then referred to the Chest Diseases Department of School of Medicine, Ege University and the radio-opaque object in the right intermediate bronchus was diagnosed to be an aspirated dental prosthesis. Subsequent to the failure of the rigid bronchoscopy, the patient was referred to the Thoracic Surgery Department and had to be operated for retrieval of the foreign body. [source]

Effects of Intravenously Administrated Omeprazole on Gastric Juice pH and Gastric Ulcer Scores in Adult Horses

JOURNAL OF VETERINARY INTERNAL MEDICINE, Issue 5 2006
Frank M. Andrews
The study was performed to evaluate the efficacy of omeprazole powder in sterile water, administered intravenously, on gastric juice pH in adult horses with naturally occurring gastric ulcers. Omeprazole (0.5 mg/kg, IV) was administered once daily for 5 days to adult horses with gastric ulcers. Gastric juice was aspirated through the biopsy channel of an endoscope and pH was measured before and 1 hour after administration of omeprazole on day 1, and then before and after administration of omeprazole on day 5. Gastric ulcer scores were recorded on day 1 before administration of omeprazole and on day 5, 23 hours after the 4th daily dose. Gastric juice pH and ulcer scores were compared between the times. When compared with the pre-injection value (2.01 ± 0.42), mean ± SD gastric juice pH was significantly higher when measured 1 hour after administration of the initial dose (4.35 ± 2.31), and before (5.27 ± 1.74) and 1 hour after (7.00 ± 0.25) administration of omeprazole on day 5. Nonglandular gastric ulcer number score significantly decreased from a mean ± SD of 3.2 ± 0.80 to 2.0 ± 1.1, but nonglandular gastric ulcer severity score remained the same. Few glandular ulcers were seen in the study, and scores did not change. Because of its potent and long duration of action on gastric juice pH, this intravenous formulation of omeprazole may show promise for treatment of equine gastric ulcer syndrome (EGUS) in horses with dysphagia, gastric reflux, or other conditions that restrict oral intake of omeprazole paste.a Aspiration of gastric juice and measurement of pH can be of use to determine whether the desired pH > 4.0 has been reached after omeprazole treatment. [source]

Usefulness of Fine-Needle Aspiration in Subcutaneous Fat Necrosis of the Newborn Diagnosis

PEDIATRIC DERMATOLOGY, Issue 3 2010
Verónica López M.D.
No abstract is available for this article. [source]

Aspiration during swallowing in typically developing children of the first nations and inuit in Canada

PEDIATRIC PULMONOLOGY, Issue 10 2006
Gina R. Rempel MD
Abstract Children of the First Nations and Inuit in Canada have a high propensity for lower respiratory tract infections. Overcrowding, poor housing, passive smoke exposure, and lack of breast feeding (Martens P, Bond R, Jebamani L, Burchill C, et al. http://www.umanitoba.ca/centres/mchp/reports/pdfs/rfn_pdfs/rfn_report.pdf.; MacMillan H, Walsh C, Jamieson E, Crawford A, Boyle M. http://www.hcsc.gc.ca/fnihbdgspni/fnihb/aboriginalhealth/reports_summaries/regional_survey_ch1.pdf.; Wardman AE, Khan NA. Int J Circumpolar Health 2004;63:81,92) have been cited as important contributing factors in the occurrence of lower respiratory tract infections. However, aspiration during swallowing has thus far not been considered as a co-factor in the occurrence of lower respiratory tract infections in these children. We present a retrospective case series of seven typically developing children of the Canadian First Nations and Inuit, in whom aspiration during swallowing was detected in the course of investigating associations with recurrent lower respiratory tract infections. None of the children had any of the known risk factors for aspiration during swallowing such as developmental variation, prematurity, neuromotor problems, or anatomic abnormalities of the upper aerodigestive tract. We speculate that aspiration during swallowing in typically developing children may be an important, previously unrecognized co-factor in the occurrence of lower respiratory tract infections, particularly in the communities of the Canadian First Nations and Inuit. Further prospective studies will be needed to determine whether aspiration during swallowing represents an independent risk factor for the occurrence of lower respiratory tract infections in these children. Pediatr Pulmonol. 2006, 41:912,915. © 2006 Wiley-Liss, Inc. [source]

Simple and specific test for the diagnosis of aspiration into the airways using a corn flour-milk mixture in a hamster model

PEDIATRIC PULMONOLOGY, Issue 5 2003
Chaim Springer MD
Abstract Aspiration into the airways is one of the major causes of lung disease in infants and young children. Unfortunately, the diagnosis of aspiration is often delayed due to unawareness and low sensitivity and specificity of existing diagnostic tests. We tested the efficacy of a new method, using a mixture of corn flour in milk instilled into the trachea, to diagnose aspiration in a hamster model. Forty-five female hamsters were used for the experiments. Twenty hamsters underwent tracheal instillation of 0.1 ml of a mixture of 7.5% corn flour (containing starch granules with a diameter of 2,30 ,m) in milk. Twenty control animals underwent tracheal instillation of saline. Five hamsters served as naive controls. Five animals from the corn flour and saline groups underwent bronchoalveolar lavage on days 1, 3, 7, and 14 after tracheal instillation. Starch granules were identified under light microscopy, using both iodine and Diff-Quik staining in all the corn flour-instilled animals and during all days after tracheal instillation. No starch granules were detected in naive or saline-treated animals. Starch granules were detected over 14 days following tracheal instillation, with a half-life rate of disappearance of about 6 days. Corn flour aspiration in hamsters can be easily identified by light microscopy, using simple laboratory techniques. Pediatr Pulmonol. 2003; 35:400,404. © 2003 Wiley-Liss, Inc. [source]

Blinded by the Light: Aspiration and Inspiration in Political Psychology

POLITICAL PSYCHOLOGY, Issue 3 2008
George E. Marcus
First page of article [source]

Aspiration pneumonia due to polyethylene glycol-electrolyte solution (Golytely) treated by bronchoalveolar lavage

RESPIROLOGY, Issue 1 2008
Gyu-Young HUR
Abstract: Polyethylene glycol (PEG)-electrolyte solution (Golytely), is most commonly used for bowel preparation before colonoscopy, as well as for barium enema and colon surgery. In this case, a 70-year-old man developed ARDS following the administration of Golytely by mouth before a scheduled colonoscopy. Aspiration of PEG-electrolyte solution was suspected, and the patient was successfully treated by BAL. Therefore, early bronchoscopy and BAL should be considered as initial treatment for PEG aspiration, because removal of PEG is most important for managing the disease. [source]

The Use of Stereotaxic Core Biopsy and Stereotaxic Aspiration Biopsy as Diagnostic Tools in the Evaluation of Mammary Calcification

THE BREAST JOURNAL, Issue 6 2000
Joan F. Cangiarella MD
Abstract: We compared stereotaxic fine needle aspiration biopsy (SFNA) with stereotaxic core needle biopsy (SCB) in the evaluation of radiographically clustered mammary microcalcification, a common finding at screening mammography. Over a 4-year period, 181 specimens were obtained from 175 patients who underwent both SFNA and SCB of clustered microcalcification. Aspiration and core biopsies were performed by radiologists at a community-based diagnostic radiology facility. All aspiration smears were air dried, stained on site, and assessed for adequacy by the radiologists, then sent to the cytopathologists at New York University for interpretation. Core biopsy specimens were formalin fixed, paraffin embedded, hematoxylin and eosin stained, and interpreted by surgical pathologists at a community hospital. Of 181 SFNA specimens, 133 (74%) were benign, 18 (10%) were atypical, 13 (7%) were suspicious, and 16 (9%) were malignant. One (0.5%) aspiration biopsy was nondiagnostic. Excisional biopsies were performed after 12 benign SFNAs and in 46 of the 47 cases with an atypical, suspicious, or malignant diagnosis on SFNA. Mammographic follow-up in 111 of the 133 cases (92%) diagnosed as benign showed no radiologic change (mean 29.2 months, range 6,60 months). The false-negative rate for cancer was 4% (6 cases) for SFNA alone. There were no false-positive diagnoses for SFNA. There was one false-positive diagnosis on core biopsy [focal cribriform ductal carcinoma in situ (DCIS)], which at excisional biopsy and correlation with the core biopsy was diagnosed as ductal hyperplasia; the false-negative rate for cancer was 8% (13 cases) for SCB alone. Aspiration biopsy identified calcification in 180 procedures, core needle biopsy revealed calcification in 170. SFNA was superior to SCB for the confirmation of clustered mammary microcalcification (99% versus 94%) and in the identification of cancer associated with microcalcification (false negative rate of 4% versus 8%). Patients with benign findings on stereotaxic aspiration and core biopsy can reasonably be followed mammographically. [source]

Flexible Endoscopic Evaluation of Swallowing With Sensory Testing in Patients With Unilateral Vocal Fold Immobility: Incidence and Pathophysiology of Aspiration,

THE LARYNGOSCOPE, Issue 4 2005
Abtin Tabaee MD
Abstract Objectives/Hypothesis: The objective was to examine the incidence and pathophysiology of aspiration in patients with unilateral vocal fold immobility presenting with dysphagia. Study Design: Retrospective review of flexible endoscopic evaluation of swallowing with sensory testing (FEESST) data and medical records in two tertiary medical care centers. Methods: The data for all patients with unilateral vocal fold immobility who underwent FEESST between 2000 and 2003 were reviewed. Results: Eighty-one patients (45 male and 36 female patients) were included in the study. The mean age was 59 years. The most common causes or origins were iatrogenic (42%), malignancy (23%), and neurological (18%). The immobility was left-sided in 59% of patients. A majority of the patients exhibited laryngeal edema/erythema (90%), difficulty with secretions (60%), and decreased laryngopharyngeal sensation (83%). The laryngeal adductor reflex was absent in 34% of the patients. An aspiration rate of 35% was detected with thin liquids. Trials of purees revealed a 76% rate of pooling, 44% rate of spillage, 32% rate of penetration, 18% rate of aspiration, and 24% rate of regurgitation. Rates of penetration and aspiration with purees were significantly higher in patients who had decreased laryngopharyngeal sensation, absent pharyngeal squeeze, and absent laryngeal adductor reflex. Conclusion: Dysphagia in patients with unilateral vocal fold immobility is demonstrated during FEESST by pooling, spillage, penetration, and aspiration. The pathophysiology of dysphagia is multifactorial with decreased sensation and limitation of airway protective mechanisms both acting as contributing factors. [source]

Using Modified Evan's Blue Dye Test to Predict Aspiration,

THE LARYNGOSCOPE, Issue 9 2004
Article first published online: 3 JAN 200
No abstract is available for this article. [source]

Response: Using Modified Evan's Blue Dye Test to Predict Aspiration

THE LARYNGOSCOPE, Issue 9 2004
Article first published online: 3 JAN 200
No abstract is available for this article. [source]

A Pilot Study of Quantitative Aspiration in Patients with Symptoms of Obstructive Sleep Apnea: Comparison to a Historic Control Group,

THE LARYNGOSCOPE, Issue 6 2004
Michael Beal MD
Abstract Objective: It has been shown that many healthy people aspirate secretions at night. Patients with obstructive sleep apnea (OSA) have frequent episodes of gasping at night that may predispose them to aspiration. The purpose of this study was to determine whether patients with symptoms of OSA are predisposed to pharyngeal aspiration. Study Design: A prospective study in which patients with symptoms of OSA were compared with a historic group of normal controls by using the same methodology. Methods: The study was offered to patients with symptoms of OSA undergoing a sleep study. The radiotracer Technicium99 was infused through a plastic tube placed in the nasopharynx after the patient achieved stage II sleep. A chest radionuclide scan determined the amount of material aspirated. The Wilcoxon-rank sum test was used to compare the mean amount aspirated between the experimental and historic control groups. Results: Fourteen patients successfully completed the study. One normal volunteer in our study aspirated a quantity similar to the historic normal control group. The amount of aspirated material in the study group ranged from 0.152 to 3.648 mL, with a mean of 1.24 mL ± 0.905 (SD). When compared with the historic normal control group, the patients with symptoms of OSA aspirated significantly more radio-tracer (P <.01). There was a lack of association between respiratory disturbance index and amount aspirated. Conclusions: The results suggest there is an apparent risk of increased pharyngeal aspiration in patients with symptoms of OSA. [source]

Surgical Closure of the Larynx for Intractable Aspiration: Surgical Technique Using Closure of the Posterior Glottis

THE LARYNGOSCOPE, Issue 1 2003
Kiminori Sato MD
No abstract is available for this article. [source]

Videomanofluorometric Study in Amyotrophic Lateral Sclerosis

THE LARYNGOSCOPE, Issue 5 2002
Ryuzaburo Higo MD
Abstract Objective To elucidate the time-course changes of swallowing function in amyotrophic lateral sclerosis (ALS) by videomanofluorometry. Study Design Videomanofluorometry was conducted on 21 patients with ALS, who were divided into five groups according to type of disease and according to the length of time following the appearance of bulbar symptoms. Methods Videomanofluorometry, which is videofluoroscopic and manometric study conducted simultaneously, was performed on patients in the five groups, and swallowing function in each group was evaluated. Some of the patients were followed up by videomanofluorometry performed several times, and their swallowing function changes over time were investigated. Results A decrease of swallowing pressure first appeared in the oropharynx, then the hypopharynx became involved. Oropharyngeal swallowing pressure had already decreased to approximately 50 mm Hg within 6 months after the appearance of bulbar symptoms; however, hypopharyngeal swallowing pressure was relatively maintained until 1 year after the onset of bulbar symptoms. Most of the patients with ALS maintained normal upper esophageal sphincter relaxation, but upper esophageal sphincter spasm was seen in some patients with ALS. Aspiration was seen in eight cases, five of which showed upper esophageal sphincter spasm. Conclusions Patients with ALS gradually face the danger of aspiration as decreases of oropharyngeal and hypopharyngeal swallowing pressure progress. Upper esophageal sphincter spasm occurs in some patients with ALS, and it is an important cause of aspiration. Both videofluoroscopic and manometric evaluation are necessary to assess these conditions, and they are quite useful for follow-up of swallowing function in patients with ALS. [source]

Immediate Percutaneous Medialization for Acute Vocal Fold Immobility With Aspiration,

THE LARYNGOSCOPE, Issue 8 2001
Timothy D. Anderson MD
Abstract Objectives To determine the efficacy of immediate bedside or office percutaneous, trans-thyroidal injections of a bioabsorbable gelatin material (Gelfoam, Upjohn Co., Kalamazoo, MI) to decrease the risk of aspiration resulting from acute vocal fold immobility. Study Design Retrospective review of patients presenting with acute vocal fold immobility and aspiration or high aspiration risk at an urban, tertiary care university hospital. Methods All patients were evaluated by videostroboscopy, functional endoscopic evaluation of swallowing (FEES), and objective voice measures. Patients with acute vocal fold immobility and evidence of aspiration on history or FEES were given the option of medialization by Gelfoam injection. Injections were performed percutaneously in the office or at the bedside under laryngoscopic guidance. FEES was repeated after injection to verify improvement in aspiration. Results Eleven patients underwent Gelfoam injection for treatment of aspiration and vocal fold immobility. All were significantly improved on post-injection FEES study. All patients were returned to an oral diet, avoiding the need for long-term enteral access. Conclusion Percutaneous Gelfoam injections is a rapid, temporary solution to the common problem of aspiration resulting from acute vocal fold immobility. [source]

The effect of ranitidine versus proton pump inhibitors on gastric secretions: a meta-analysis of randomised control trials

ANAESTHESIA, Issue 6 2009
K. Clark
Summary Aspiration of acid into the lungs is an infrequent but potentially devastating complication of general anaesthesia. Routine practice often includes use of pharmacological agents to reduce gastric volume and increase gastric pH. The aim of this study was to compare the net benefit of proton pump inhibitors with histamine 2 blockers in a meta-analysis. Electronic databases were searched for trials that compared ranitidine vs proton pump inhibitors in their effect on volume and pH of gastric fluid aspirates. We identified nine trials of which seven were suitable for meta-analysis. Pooled outcomes suggest that premedication with ranitidine is more effective than proton pump inhibitors in reducing the volume of gastric secretions (by an average of 0.22 ml.kg,1; 95% confidence interval 0.04,0.41) and increasing gastric pH (by an average of 0.85 pH units; 95% confidence interval ,1.14 to ,0.28). [source]

Numerical Simulation of Thrombus Aspiration in Two Realistic Models of Catheter Tips

ARTIFICIAL ORGANS, Issue 4 2010
Giancarlo Pennati
Abstract Thrombus aspiration catheters are devices used to remove a blood clot from a vessel, usually prior to angioplasty or stent implantation. However, in vitro results showed that the use of different commercial devices could produce very different thrombus removals, suggesting a primary dependence on the distal tip configuration of the catheter. A computational methodology based on realistic catheter tip modeling was developed to investigate the factors affecting the thrombus suction. Two different designs were considered, either with a single central lumen or a combination of central and side holes. First, steady-state aspiration of distilled water from a reservoir was simulated and compared with experimental tests. Subsequently, the aspiration of a totally occlusive thrombus, modeled as a high viscous fluid, was simulated solving a complex two-phase (blood and thrombus) problem. In particular, the benefit of additional openings was investigated. Good matching between the steady-state experimental and numerically simulated hydraulic behaviors allowed a validation of the numerical models. Numerical results of thrombus aspiration showed that the catheter with central and side holes had a worse performance if compared with the single central lumen catheter. Indeed, the inlets in contact with both blood and thrombus preferentially aspirate blood due to its much lower viscosity. This effect hindered the aspiration of thrombus. The amount of aspirated thrombus highly depends on the complex, two-phase fluid dynamics occurring across the catheter tips. Results suggested that location of additional holes is crucial in the catheter aspiration performance. [source]

A Novel Approach to Teaching Periocardiocentesis

ACADEMIC EMERGENCY MEDICINE, Issue 2009
Mara Aloi
Pericardiocentesis can be a life-saving intervention but it is associated with significant complications if not performed appropriately. Periocardiocentesis should ideally be done under ultrasound guidance. However, in many community emergency departments (EDs) ultrasound is not routinely available, leaving the ED physician the anatomic approach. Emergency medicine residents need to achieve competence in this procedure using both techniques, but there are limited opportunities for residents to perform this procedure on live patients. Many residency programs teach this procedure using cadaver models. We have devised a model, made with readily available, inexpensive materials, that allows residents to practice pericardiocentesis using both the subxiphoid and parasternal approach in a setting that we feel is more life-like than with that using the dessicated tissue of routine cadaver models. Materials: Two racks of pork or beef ribs, wire, pericardiocentesis tray, Betadine, plastic baggies. The racks of ribs are wired together to make a thorax and are then covered with an opaque covering to simulate skin. One plastic bag is filled with Betadine and then placed within another plastic bag containing water, to simulate pericardial effusion. The bag-within-bag set-up is then secured on the under surface of the thorax. Residents can then practice either the parasternal or subxiphoid approach with the intent of aspirating clear fluid. Aspiration of dark-fluid represents cardiac penetration and is considered an unsuccessful procedure. Bags can be replaced as needed, but based on our experience, approximately 10 attempts were done before any significant leakage occurred. Total cost for the materials was less than $35. [source]

Frequency and prognostic relevance of disseminated tumor cells in bone marrow of patients with metastatic renal cell carcinoma

CANCER, Issue 7 2006
Alexander Buchner M.D.
Abstract BACKGROUND The prognostic relevance of disseminated cytokeratin-positive (CK+) tumor cells in the bone marrow of patients with different types of carcinoma has been demonstrated in several studies. In this prospective study, the frequency and prognostic value of CK+ tumor cells was investigated in the bone marrow of 55 consecutive patients with metastatic renal cell carcinoma (M1 RCC) in comparison with 256 M0 RCC patients from a previous study. METHODS Aspiration of bone marrow from the anterior iliac crest was performed immediately before tumor resection in RCC patients. Cytospins were made and stained by immunocytochemistry using the APAAP (alkaline phosphatase-antialkaline phosphatase) protocol and monoclonal antibodies CK2 and A45-B/B3. Twenty-seven patients with no evidence of any malignant disease served as a control group. RESULTS CK+ tumor cells were detected in 42% (23 of 55 patients) of the M1 patients and 25% (63 of 256 patients) of the M0 patients (P <.01). No CK+ cells (0 of 27 patients) were detected in the control group. In the M1 group, CK, patients demonstrated a trend toward a better outcome compared with CK+ patients (log-rank test, P = .19). This difference was significant when applying a higher threshold (0,2 CK+ cells vs. , 3 CK+ cells; P <.05). On multivariate analysis, the detection of , 3 CK+ cells in the bone marrow was found to be an independent prognostic factor (P <.001). CONCLUSIONS The results of the current study indicate that disseminated CK+ cells play a role in the biology of tumor spread of RCC, and that their immunocytochemical detection can be useful in assessing the prognosis of patients with M1 disease. Cancer 2006. © 2006 American Cancer Society. [source]

Feasibility and applicability of computer-assisted myocardial blush quantification after primary percutaneous coronary intervention for ST-segment elevation myocardial infarction,

CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, Issue 5 2010
Joost D.E. Haeck MD
Abstract Objectives: The aim of the study was to evaluate whether the "Quantitative Blush Evaluator" (QuBE) score is associated with measures of myocardial reperfusion in patients with ST-segment elevation myocardial infarction (STEMI) treated in two hospitals with 24/7 coronary intervention facilities. Background: QuBE is an open source computer program to quantify myocardial perfusion. Although QuBE has shown to be practical and feasible in the patients enrolled in the Thrombus Aspiration during Percutaneous Coronary Intervention in Acute Myocardial Infarction Study (TAPAS), QuBE has not yet been verified on reperfusion outcomes of primary percutaneous coronary intervention (PCI) patients treated in other catheterization laboratories. Methods: Core lab adjudicated angiographic outcomes and QuBE values were assessed on angiograms of patients who were enrolled in the PRoximal Embolic Protection in Acute myocardial infarction and Resolution of ST-Elevation (PREPARE) trial. ST-segment resolution immediately after PCI measured by continuous ST Holter monitoring was calculated by a blinded core lab. Results: The QuBE score could be assessed on 229 of the 284 angiograms (81%) and was significantly associated with visually assessed myocardial blush grade (P < 0.0001). Patients with improved postprocedural Thrombolysis in Myocardial Infarction-graded flow, myocardial blush grade, ST-segment resolution immediately after PCI, or a small infarct size measured by peak CK-MB had a significant better QuBE score. Conclusions: QuBE is feasible and applicable at angiograms of patients with STEMI recorded at other catheterization laboratories and is associated with measures of myocardial reperfusion. © 2010 Wiley-Liss, Inc. [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]

Political Economy of Immigration in Germany: Attitudes and Citizenship Aspirations,

INTERNATIONAL MIGRATION REVIEW, Issue 2 2009
Martin Kahanec
This paper examines resident foreigners' interest in German citizenship. We use a unique data set from a survey of foreign residents in the German states to study the roles played by factors such as attitudes towards foreigners and political interest of foreigners. We find that negative attitudes towards foreigners and generational conflict within foreigner families are significant negative factors. While interest in political participation is among the important positive factors, hostile attitudes, lack of voting rights, or uncertainty about staying in Germany mainly discourage foreigners who actively participate in the labor market, have more years of schooling, and are younger. [source]

Dollar Dominance, Euro Aspirations: Recipe for Discord?

JCMS: JOURNAL OF COMMON MARKET STUDIES, Issue 4 2009
BENJAMIN J. COHEN
After nearly a century of dominance of the international monetary system, has the US dollar finally met its match in the euro? When Europe's economic and monetary union (EMU) came into existence in 1999, many observers predicted that the euro would soon join America's greenback at the peak of global finance. Achievements, however, have fallen short of aspiration. After an initial spurt of enthusiasm, international use of the euro actually appears now to be levelling off, even stalling, and so far seems confined largely to a limited range of market sectors and regions. The euro has successfully attained a place second only to the greenback , but it remains, and is likely to remain, a quite distant second without a determined effort by EMU authorities to promote their money's global role. The temptation will surely be great. In practical terms, it is difficult to imagine that EMU authorities will refrain entirely from trying to promote a greater role for the euro. But that, in turn, could turn out to be a recipe for discord with the United States, which has never made any secret of its commitment to preserving the greenback's worldwide dominance. A struggle for monetary leadership could become a source of sustained tensions in US,European relations. Fortunately, however, there seems relatively little risk of a destabilizing escalation into outright geopolitical conflict. [source]