Open lung biopsy with local anesthesia

Open lung biopsy may be required in the patients with parenchymal lung disease who do not have a clearly defined diagnosis. There is no doubt thoracotomy with general anesthesia is preferable to local anesthesia; but it is associated with high risks in the severally ill patients. The aim of this study is to review our experience and compare the efficacy and complications of using local anesthesia versus general anesthesia for open lung biopsies in high risk patients. From January 2002 to September 2004, Twenty five patients [18 males, 7 females] underwent open lung biopsy using minithoracotomy in the Baqiyatallah hospital in Tehran. 14 [56%] of them had open lung biopsy using general anesthesia [GA] and 11 [44%] selected for this procedure with local anesthesia [LA], all of LA group were excluded from GA because of their poor condition. we reviewed effectiveness of LA for minithoracotomy and also compared the safety, accuracy and various complications of this procedure between the two methods of anesthesia. The mean age in the first [GA] group was 42.5 [ +/- 14.7] years and in the second [LA] group was 49.6 [ +/- 12.2] years [NS]. The average length of hospital stay, postoperative air leak, and the diagnostic accuracy was not significantly different between the two groups. There was one operative-related mortality in the second group [NS]. In selected patients with diffuse lung disease or peripheral lesions Local anesthesia is an acceptable substitute to general anesthesia for minithoracotomy to obtain adequate lung tissue for accurate diagnosis

[ efficacy of horse collagen[Antema] in hemostasis of bleeding due to dental procedures, pilonidal sinus surgery, hemorrhoidectomy and laminectomy]

Hemostasis and control of bleeding are important principles in surgery. Control of bleeding with normal procedures such as cauterization and ligation is sometimes hard and even impossible. Considering different effects of collagen including hemostasis acceleration, complete absorption, tissue repair, and flexibility and appropriate traction, it can help maintain hemostasis. In a randomized controlled clinical trial, 92 cases and 91 controls were compared. Horse collagen [Antema] was used in cases while routine procedures were implemented in controls. Patients were evaluated in 4 groups involving dental procedures, pilonidal sinus open surgery, hemorrhoidectomy, and laminectomy. Statistical indices such as mean, standard error, and statistical tests such as t-test and chi-square were used in the analysis. Mean age was 29.48 +/- 1.29 in the cases and 33.2 + 1.5 in the control group. Seventy four [36 cases, 38 controls] undergoing dental procedures, 61[31 cases, 30 controls] pilonidal sinus open surgeries, 31[18 cases, 18 controls] hemorrhoidectomies, and 12[7 cases, 5 control] laminectomies were investigated. Despite higher severity of bleeding in cases [p=0.011, r=0.247], the time of bleeding control [p<0.001] and the time of complete hemostasis[p<0.001] were lower in cases than in the control group. Antema is effective in hemostasis and it may be used as an adjunct material in hemostasis

Value of fine needle aspiration in diagnosis of palpable breast masses

Fine needle aspiration [FNA] as a cytological method for the evaluation of breast masses was first performed in 1930, and of present is used as a routine method for the evaluation of breast masses. Aspiration via fine needle as a diagnostic tool is easy, accessible and relatively non - invasive. The purpose of this study was to determine the diagnostic value of this method and its comparison with open biopsy in determining the nature of breast masses. This prospective study included 62 females with palpable breast masses who were candidates for breast biopsy. Mean age was 43.7 +/- 14.3 years [16-68 years]. All patients had palpable breast masses and underwent FNA prior to conventional open breast biopsy Excised tissues and FNA samples were studied by a pathologist who was blinded to the patient's name and her medical history. According to histopathological exam, there were 40 [64.5%] benign and 22 [35.5%] malignant. Incidence of malignancy was higher in the larger masses. When FNA reports were compared with final histopathology reports, there was one false negative and one false positive report. Positive predictive value [PPV] and negative predictive value [NPV] were 95.5% and 96.7% respectively. This study demonstrates that FNA is safe and accurate diagnostic procedure in evaluation and diagnosis of breast masses. We recommend it to be used as the initial diagnostic test for all palpable breast masses. To avoid any misdiagnosis, open biopsy should be performed when needle aspiration is negative or the masses are clinically suspicious for malignancy