Técnica híbrida (TH) versus estándar (TS) en la punción con aguja fina guiada por ecoendoscopia para lesiones sólidas del páncreas / Hybrid technique versus standard technique for endoscopic ultrasound guided fine needle aspiration of solid pancreatic lesions

Resumen La ultrasonografía endoscópica (USE) se usa ampliamente para evaluar enfermedades pancreatobiliares, especialmente masas pancreáticas. La USE tiene una buena capacidad para detectar masas pancreáticas, pero no es suficiente para el diagnóstico diferencial de varios tipos de lesiones. La aspiración endoscópica con aguja fina guiada por ultrasonido (USE-PAF) es el método de diagnóstico de elección para masas pancreáticas y su precisión se afecta por diversos métodos de punción. Materiales y métodos: nuestro objetivo fue evaluar el rendimiento diagnóstico de la técnica de succión estándar (TS) versus la técnica húmeda híbrida (TH) en el estudio de lesiones sólidas en páncreas, utilizando un diseño prospectivo, con ocultación única, aleatorizado y controlado, que incluye a pacientes con diagnóstico de lesión sólida en páncreas a los que se realizó USE-PAF desde mayo de 2014 a junio de 2016. Resultados: en total incluimos 65 pacientes, 34 (52,3%) se asignaron a USE-PAF con TH y 31 (47,7%) pacientes a USE-PAF con TS. Se encontró que la frecuencia relativa porcentual respecto a la técnica de punción en la USE-PAF en lesiones sólidas de páncreas, que permite obtener la cantidad de tejido adecuado para el diagnóstico citológico, fue de 85,2% para la TH y 71% para la TS, con un OR de 2,35 (IC 95%; 1,2-4,7) a favor de la TH. Conclusión: este estudio sugiere que la TH es superior a la TS en el diagnóstico de las lesiones sólidas del páncreas, por lo cual, dado que la implementación de esta técnica no aumenta costos y es muy sencilla, sugerimos que sea la técnica de elección cuando se necesita puncionar una lesión sólida.

Abstract Endoscopic ultrasound (EUS) is widely used to evaluate pancreatobiliary diseases, especially pancreatic masses. EUS has a good ability to detect pancreatic masses, but it is not sufficient for differential diagnoses of various types of lesions. Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is the diagnostic method of choice for pancreatic masses, but its accuracy is affected by various puncture methods. Materials and methods: Our objective was to compare the diagnostic yield of examinations of solid lesions in the pancreas by the standard suction technique (ST) with the yield of the hybrid technique (HT) using a prospective, single blind, randomized, controlled design. Patients diagnosed with solid pancreatic lesions who underwent EUS-FNA from May 2014 to June 2016 were included. Results: We included 65 patients, 34 of whom (52.3%) were assigned to EUS-FNA with HT, and 31 of whom (47.7%) were assigned to EUS-FNA with TS. We found that the relative frequency that HT successfully obtained an adequate amount of tissue for the cytological diagnosis was 85.2% while ST's relative frequency of success was 71%. The odds ratio was 2.35 (95% CI; 1.2-4.7) in favor of HT. Conclusion: This study suggests that the TH is superior to ST for diagnosis of solid pancreatic lesions. Since implementation of this technique does not increase costs and is very simple, we suggest that it become the technique of choice for EUS-FNA.

The clinical application of CT-guided percutaneous coaxial needle biopsy combined with microwave ablation for lung tumors / 介入放射学杂志

Objective To evaluate the effect of CT-guided percutaneous coaxial needle biopsy combined with microwave ablation (MWA) for the treatment of lung tumors, and to discuss its technique, safety, curative effect and clinical application value. Methods A total of 20 patients with lung tumor, who were admitted to the Department of Interventional Radiology, Shanghai Ruijin Hospital, China, during the period from August 2014 to June 2016, were collected. Among the 20 patients, primary pulmonary cancer was diagnosed in 9 and metastatic tumor in 11. A total of 23 tumor lesions were detected, and CT-guided percutaneous coaxial needle biopsy combined with MWA was performed for all lesions. Based on the size and shape of the tumor, the corresponding ablation power and time of duration were set up. After the treatment, the patients were followed up for 4-26 months, and chest enhanced CT examination was regularly reexamined to assess the curative effect. Results Percutaneous coaxial needle biopsy was carried out for 23 lesions, the tumor diameters ranged from 0.80 cm to 2.40 cm, with a mean of 1.39 cm. MWA was employed for 23 lesions. CT scan performed immediately after MWA showed that the density of tumor lesion became decreased, the diagnostic positive rate of needle biopsy was 83.3％. After the treatment, complete remission was obtained in 15 patients, partial remission in 2 patients, stable disease in one patient, and progression.

Effect of Neonatal Axillary Vein Indwelling Needle Puncture / 昆明医科大学学报

Objective To investigate the application effect of indwelling needle puncture in the axillary vein of newborn infants.Methods From September 2015 to February 2016,the venous indwelling needle puncture was given for neonatal transfusion 180 cases,including 90 cases of the axillary vein indwelling needle infusion in the experimental group,and 90 cases of puncture of extremity vein infusion in the control group.The application effect of the 2 groups was compared.Results There were significant differences in terms of indwelling needle shedding,phlebitis,drug extravasation,lien time between the experimental group and the control group (P ＜ 0.05) Conclusions During neonatal indwelling needle puncture infusion process,the axillary vein indwelling needle infusion can prevent the indwelling needle shedding,decrease the incidence of phlebitis and reduce the incidence of drug extravasation,and can prolong the indwelling time.Puncture in the simple operation easy,is easy to learn and no need for special facilities and equipment,only conventional intravenous infusion required material,plus 24g indwelling needle,aseptic transparent dressing,paper tape,economical and practical,suitable for application in neonatal ward.

Study on success rate and influencing factors of peripheral indwelling needle puncture in pediatric patients / 中国实用护理杂志

Objective To identify the success rate of peripheral indwelling needle puncture in pediatric patients, and analyze its influencing factors. Methods A survey was conducted in a sample of 902 pediatric patients.Personal information table of pediatric patients who receive infusionwas adopted to collect data. Results The success rate of first puncture was 85.37%(770/902), the success rate of two punctures was 95.34%(860/902). The success rate was affected by several factors, such as department, ages of the patients, condition of the veins, years of working as a nurse(OR=1.128, 2.308, 2.351, P <0.05). Conclusions Success rate of peripheral indwelling needle puncture in children still can be improved. When formulate management program, the influencing factors should be considered for management standard.

UNTRASONOGRAPHICALLY GUIDED FINE NEEDLE PUNCTURE ABSORBING CYTOLOGY EXAMINATION IN THE DIAGNOSIS OF CERVICAL LYMPH NODE TUBERCULOSIS / 现代医院

Objective To explore the clinical value of untrasonographically guided fine needle puncture ab -sorbing cytology examination in the diagnosis of cervical lymph node tuberculosis .Methods In March 2013 to June 2015 454 cases of suspected cervical lymph node tuberculosis cases were selected , and 454 suspected cases according to the voluntary principle were divided into two groups : US -FNAC groups: 326 cases with US -FNAC detection;FNAC groups: 128 cases, using FNAC.Statistical degree of two groups of detection sensitivity , specific, positive predictive value, negative predictive value and accuracy , and follow -up of two groups of complications .Results In US -FNAC group 326 cases, after the US -FNAC tested positie 308 cases, 304 cases confirmed by pathology after true positive and false positive 4 cases, through US -FNAC tested negatie 18 cases, were confirmed by pathology af -ter true negative, 15 cases of false negative in 3 cases; FNAC in the group of 128 cases of FNAC tested positie 107 cases, 102 cases confirmed by pathology after true positive and false positive in 5 cases, by FNAC tested negatie 21 cases, 12 cases confirmed by pathology after really negative , 9 cases of false negative.US -FNAC, the sensitivity of the detection of cervical lymph node tuberculosis (99.02%) than FNAC (91.89%), the difference was statisti-cally significant (p 0.05); US -FNAC, the accuracy of the detection of cervical lymph node tuberculosis (95.30%) than FNAC (89.47%), the difference was statistically significant (p <0.05); US - FNAC, incidence of complications (1.23%) is lower than the FNAC group (4.69%), and the difference was statistically significant (chi -square =5.1095, p =5.1095,p <0.05). Conclusion US -FNAC is used for the diagnosis of cervical lymph node tuberculosis , and has the advantages of high sensitivity, high accuracy.So US -FNAC diagnosis in cervical lymph node tuberculosis suspected cases has the important clinical value.

Diagnóstico citológico de lesiones focales intra-abdominales en pacientes que acuden al Servicio de Gastroenterología del Hospital Central Universitario “Antonio María Pineda”: Barquisimeto-Estado Lara / Cytological diagnosis of intra-abdominal focal lesions in patients attending the Hospital Central Universitario

Las lesiones focales de los órganos intra - abdominales comprenden un amplio espectro, produciendo desde pocas o inaparentes consecuencias, hasta un deterioro significativo de la calidad de vida pudiendo representar una condición severa asociada con mal pronóstico y alta mortalidad. Determinar el diagnóstico citológico de lesiones focales intra-abdominales mediante punción aspiración con aguja fina en pacientes que acuden al Servicio de Gastroenterología del Hospital Central Universitario “Antonio María Pineda”. Barquisimeto. Estado Lara. Se realizó una investigación de tipo descriptiva transversal, practicándose punción aspiración con aguja fina a todos los pacientes con lesiones focales intra-abdominales que acudierón al Servicio de Gastroenterología del HCUAMP durante el periodo Julio 2008 - Diciembre 2008 excluyéndose aquellos con ausencia de un trayecto seguro para la aguja, poca abordabilidad de la lesión, trastornos de coagulación o trombocitopenia severa, infecciones de la piel en el área de la punción, enfermedades neurológicas agudas, estado crítico o terminal y pacientes poco colaboradores. 62% de los pacientes con lesiones focales intra-abdominales pertenecían al sexo femenino y 38% al sexo masculino. 54% de los pacientes tenían entre 40 y 69 años. La localización intra-abdominal más frecuente de las lesiones fue Hígado en 84%, Páncreas en 10% Retroperitoneo en 4% y Bazo en 2%. La categoría citológica fue benigna en 30% seguido de 23% maligna y 7% sospechosa para malignidad mientras que en 37% no se reportaron hallazgos citológicos patológicos. El diagnóstico citológico más frecuente de las lesiones benignas fue Absceso en 65%. De los pacientes con lesiones categorizadas como malignas, 62% presentó diagnóstico citológico de Adenocarcinoma, 15% Carcinoma, 15% neoplasia epitelial neuroendocrina y 8% Linfoma. No se presentaron complicaciones. La principal limitación fue la no disponibilidad de patólogo en el momento de la toma de las muestra...

Focal lesions in intra-abdominal organs comprehend a wide spectrum, resulting into a few or non-apparent consequences up to a significant damage of living standards, which might represent a severe condition associated with a bad patient outlook and high morbidity. Determining the cytological diagnosis of intraabdominal focal lesions by puncture/aspiration with fine needle in patients attending the Hospital Central Universitario Antonio Maria Pineda’s (HCUAMP) Gastroenterology Service, at Barquisimeto, State of Lara. A cross-sectioned descriptive research was developed; fine-needle puncture/aspiration was practiced on all patients with intra-abdominal focal lesions who attended the HCUAMP’s Gastroenterology Service between July-September 2008, excluding those who did not show a safe routing for the needle, scarce approachability to the lesion, coagulation disturbances, severe thrombocytopenia, skin infection on the puncture area, acute neurologic diseases, critical or terminal stage, and uncooperative patients. 62% of patients with intra-abdominal focal lesions were female, and 38% were male. 54% of patients were between 40 and 69 years old. The most frequent intra-abdominal lesions were: Liver, 84%; Pancreas, 10%; retroperitoneum, 4%; and Spleen, 2%. Cytological category was 30% benign, followed by 23% malignant; and 7% probably malignant, while 37% did not report pathologic cytological findings. The most frequent cytological diagnosis in benign lesions was 65% of abscess. From the patients with lesions categorized as malignant, 62% presented a cytological diagnosis of adenocarcinoma; 15%, Carcinoma; 15%, neuroendocrinal epithelial neoplasm; and 8% Lymphoma. No complications were present. The non availability of pathologist at the time of sample collection was the main limitation. The puncture/aspiration by ultrasound-guided fine needle in intraabdominal focal lesions is a rapid and efficient diagnosis alternative, rendering high specificity...

A Case of Endoscopic Removal of a Broken off Gastric Balloon from a Sengstaken-Blakemore Tube / 대한소화기내시경학회지

A Sengstaken-Blakemore (S-B) tube, when used approximately, still has a place in the management of acute variceal bleeding, and controls bleeding in 40~90% of the cases. However its use is accompanied by number of complications such as esophageal ulcer, pulmonary aspiration, and malfunction of the tube, which requires replacement. We recently observed a very unusual complication: the remaining gastric balloon of a S-B tube was broken off in the fundus of stomach by the patient's traction. The gastric balloon was easily and safely removed using an endoscopic snare after deflating the gastric balloon with a needle puncture.

Evaluation of CT-guided biopsy in diagnosing space-occupying lesions of the pancreas / 介入放射学杂志

Objective To assess the diagnostic value of CT-gnided pereutaneous fine-needle aspiration biopsy (FANB) for the space-occupying lesions of the pancreas. Methods The authors retrospectively reviewed the medical records of 68 patients with pancreatic lesions who underwent CT-guided percutaneous fine-needle aspiration biopsy. The lesions were located at the pancreatic head (n = 49), body (n = 12) or tail (n = 7). The maximum diameter of the 68 lesions ranged from 2 cm to 7 cm. The lesion's diameter was < 3 cm in 10 cases and was ≥ 3 cm in 58 cases. A 20-gauge fine-needle was used to puncture and to make the aspiration in all patients. Both plain and contrast-enhanced abdominal CT scanning were performed before the biopsy procedure. The technical key points of aspiration biopsy included selection of the appropriate cross-section, the entry of the needle, and multiple insertions in fan-like fashion with fast manipulation of puncture and aspiration. All biopsy specimens were sent for pathologic evaluation. Results All the lesions were safely and successfully punctured through the anterior approach without major complications. The technical success of needle puncturing was 100%. Of 68 patients, the pathological results obtained from the biopsy included malignant tumor in 46, benign lesion in 17 and no abnormal finding in 5, of which follow-up observation found no abnormality in 2 and malignant process was eventually confirmed in remaining three. The overall accuracy, specificity and sensitivity of the biopsy were 96%, 95% and 100%, respectively. The accuracy of CT-guided biopsy for malignant and benign lesions was 94% and 100% respectively (P > 0.05). The diagnostic accuracy for lesions larger than 3.0 cm (97%) or located at the pancreatic tail (100%) was a little higher than that for lesions smaller than 3.0 cm (90%) or located at the pancreatic head (96%) or body (92%), although the difference was not statistically significant (P > 0.05). No serious complications occurred in our series. Conclusion CT-guided percutaneous fine-needle aspiration biopsy is a safe and effective technique for the diagnosis and differentiation of the space-occupying lesions of the pancreas.

Observation on the Efficacy of Acupuncture Combining with Chinese Herbal Medicine for Treating 37 Sciatica Patients / 医学研究杂志

Objective To investigate the clinical efficacy of fire needle puncture combining with chinese herbal medicine for treating sciatica. Methods Sciatica outpatients were randomly allocated to a Fire needle puncture plus chinese herbal medicine of 37 cases( treatment group) and a western medication group of 32cases( comparison group). In the former, fire needle puncture and chinese herbal medicine was performed for two or three treatment courses; in the latter, only western medication was given during the same period. Results A comparison of the curative effects at one day after the treatment showed that the marked efficacy rate and effective rate in the treatment group were 78.4% and 97.20% respectively, and in the comparison group was 43.8% and 84.4%. The comparison of the curative effects between the two groups showed that all these patients got better in the treatment group than in the comparison groups and there was very significant difference ( P

A Case of Primary Inoculation Tuberculosis / 대한피부과학회지

Primary inoculation tuberculosis, also called tuberculosis chancre or tuberculosis primary complex, is the result of direct inoculation of M. tuberculosis in the skin of a host who has not been infected. A 33-year-old laboratory male presents with painless erythematous nodule and central ulcer on the left middle finger for 3 weeks. The skin lesion was developed after he punctured his finger with a needle containing M. tuberculosis. He had no history of tuberculosis. Histopathologic finding showed a wedged shaped abscess mixed with nuclear dust and eosinophils in the epidermis, and inflammatory cell infiltrations and caseation necrosis within the granuloma in the dermis. No bacillus was found in the lesion on AFB stain. We performed polymerase chain reaction with lesional tissue and obtained a positive result. So we diagnosed this case as a primary inoculation tuberculosis, and started antituberculosis medication. After 2 months of treatment, the erythema and ulcer improved. The patient completed a 9 months course of antituberculosis therapy without complication.

Neural Tube Defect of Chick Embryos by Needle Puncture and Albumen Removal

OBJECTIVE: The animal research of embryonic teratogenesis is widely performed and the neural tube defects are also studied through various animal models. Particularly, the experimental research on chick embryos is performed with great popularity. In this experiment we studied the effect of albumen removal and the needle puncture on the development of neural tube defects in chick embryos. METHODS: The domestic hen eggs of control group are incubated for 14 days at 37.5degreesC and 70% humidity. The experimental group was divided into three groups, needle puncture group, 5 cc albumen removal group and 10 cc albumen removal group after the eggs were incubated for 24-28 hours and incubated for another 13 days after the puncture with or without albumen removal. After 14 days of incubation, all the embryos were isolated and morphologically characterized. RESULTS: Of 39 incubated chick embryos in control group, 31 embryos were grown as normal and 8 embryos were grown as anomalous. The numbers of total(normal/anomalous/developmentally arrest) embryos of each group were 37(14/16/7), 37(9/17/11), and 37(6/13/18) in the needle puncture, 5cc albumen removal and 10cc albumen removal groups, respectively. Needle puncture increased the teratogenesis of chick embryos significantly but did not increase the neural tube defect. In cases of 5 cc albumen removal, the teratogenesis of chick embryos was increased to a significant level and the incidence of neural tube defect was increased significantly. In cases of 10 cc albumen removal, not only teratogenesis but also growth arrest were increased markedly. Therefore, it was not considered to be an adequate experimental model. CONCLUSIONS: This results indicate that needle puncture itself to remove the albumen from chick embryos had nothing to do with the neural tube defects and therefore its effect can be excluded. Needle puncture and albumen removal cause not only neural tube defects but other malformations such as abdominal wall defects, developmental arrest, and malformation of eyes.