Analysis of 53 cases of transjugular liver biopsy / 中华肝脏病杂志

Objective: To investigate the practicability and safety of transjugular liver biopsy (TJLB). Methods: Data of 53 cases with transjugular liver biopsy from June 2015 to June 2020 were collected. LABS-100 was used in all patients who underwent transjugular liver biopsy. Among them, 45 cases and eight were biopsied via hepatic vein and intrahepatic segment of the inferior vena cava. The surgical indications, related complications, and postoperative pathological diagnosis were analyzed and summarized. Results: TJLB was successful in all patients, with an average of 2.8 punctures per case. Satisfactory liver tissue and histopathological diagnosis was obtained in all patients. Two cases developed a cervical hematoma that was improved spontaneously, and one patient developed an intrahepatic hematoma that was improved after conservative treatment. Conclusion: TJLB is a practical and safe method for patients with contraindications to percutaneous liver biopsy.

Recent advances in diagnosis of pulmonary nodule / 中华外科杂志

With the popularization of health screening and the widespread use of low-dose computed tomography, the detection rate of lung nodules has increased year after year. However, the false positive rates testified by surgery of these lung nodules are still high. Therefore, it is vital in clinical practice to avoid overtreatment or undertreatment. But a series of problems on how to make an accurate diagnosis, how to reduce the psychological pressure of patients and follow up with regular imaging, how to clarify the indications for surgery and adopt the most minimally invasive diagnosis and treatment methods, etc. remain unsolved. Over the past decade, the diagnostic techniques for pulmonary nodules have improved significantly, including imaging progress such as the optimization of traditional imaging techniques (CT, MRI) and the emergence of new technologies (radiomics, artificial intelligence). In addition, histological improvements including percutaneous transthoracic needle biopsy, bronchoscopy, and minimally invasive surgical biopsy, etc. have brought more reliable and precise options for characterization of pulmonary nodules.

Acute prostatitis after prostate biopsy under ciprofloxacin prophylaxis with or without ornidazole and pre-biopsy enema: analysis of 3. 479 prostate biopsy cases

ABSTRACT Objectives: To investigate the characteristics of cases of NIH category I acute prostatitis developed after transrectal prostate biopsy and clarifiy the risk factors and preventive factors. Materials and Methods: We retrospectively reviewed the medical records of 3.479 cases of transrectal ultrasound-guided needle biopsies performed with different prophylactic antibiotherapy regimens at two different institutions between January 2011 and February 2016. The patients of Group I have received ciprofl oxacin (n=1.523, 500mg twice daily) and the patients of Group II have received ciprofl oxacin plus ornidazole (n=1.956, 500mg twice daily) and cleansing enema combination as prophylactic antibiotherapy. The incidence, clinical features and other related microbiological and clinical data, were evaluated. Results: Mean age was 62.38±7.30 (47-75), and the mean prostate volume was 43.17±15.20 (21-100) mL. Of the 3.479 patients, 39 (1.1%) developed acute prostatitis after the prostate biopsy procedure. Of the 39 cases of acute prostatitis, 28/3.042 occurred after the first biopsy and 11/437 occurred after repeat biopsy (p=0.038). In Group I, 22 of 1.523 (1.4%) patients developed acute prostatitis. In Group II, 17 of 1.959 (0.8%) patients developed acute prostatitis. There was no statistical difference between the two groups according to acute prostatitis rates (X2=2.56, P=0.11). Further, hypertension or DM were not related to the development of acute prostatitis (P=0.76, X2=0.096 and P=0.83, X2=0.046, respectively). Conclusions: Repeat biopsy seems to increase the risk of acute prostatitis, while the use of antibiotics effective for anaerobic pathogens seems not to be essential yet.

The role of endobronchial ultrasound-guided transbronchial needle aspiration in isolated intrathoracic lymphadenopathy in non-neoplastic patients: a common dilemma in clinical practice / O papel da aspiração transbrônquica com agulha guiada por ultrassonografia endobrônquica na linfonodomegalia intratorácica isolada em pacientes não neoplásicos: um dilema comum na prática clínica

ABSTRACT Objective: To determine the diagnostic yield of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in non-neoplastic patients with isolated intrathoracic lymphadenopathy (IL). Methods: This was a retrospective study of patients with isolated IL referred for EBUS-TBNA. We calculated the sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) of EBUS-TBNA in the diagnosis of granulomatous, reactive, and neoplastic lymphadenopathy. In cases of nonspecific granulomas, reactive lymphadenopathy, or inconclusive results, a definitive diagnosis was established by other diagnostic procedures or during a follow-up period of at least 18 months. Results: Among the 58 patients included in the study, EBUS-TBNA established a diagnosis of granulomatous disease in 22 (38%), reactive lymphadenopathy in 15 (26%), cancer in 8 (14%), and other diseases in 3 (5%). Results were inconclusive in 10 (17%), the diagnosis being established by other bronchoscopic procedures in 2 (20%) and by surgical procedures in 8 (80%). A final diagnosis of reactive lymphadenopathy was established in 12. Of those, 11 (92%) had their diagnosis confirmed during follow-up and 1 (8%) had their diagnosis confirmed by mediastinoscopy. In another 3, a final diagnosis of sarcoidosis or neoplasm was established. For the diagnosis of granulomatous disease, neoplasms, and reactive lymphadenopathy, EBUS-TBNA was found to have a sensitivity of 73%, 68%, and 92%, respectively; a specificity of 100%, 100%, and 93%, respectively; an accuracy of 86%, 93%, and 93%, respectively; a PPV of 100%, 100%, and 80%, respectively; and an NPV of 78%, 92%, and 98%, respectively. Conclusions: In non-neoplastic patients, granulomatous disease and reactive lymphadenopathy appear to be common causes of isolated IL. EBUS-TBNA shows promising results as a first-line minimally invasive diagnostic procedure. The results obtained by EBUS-TBNA can be optimized by examining clinical and radiological findings during follow-up or by comparison with the results obtained with other bronchoscopic methods.

RESUMO Objetivo: Determinar o rendimento diagnóstico da endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA, aspiração transbrônquica com agulha guiada por ultrassonografia endobrônquica) em pacientes não neoplásicos com linfonodomegalia intratorácica (LI) isolada. Métodos: Estudo retrospectivo com pacientes com LI isolada encaminhados para EBUS-TBNA. Foram calculados a sensibilidade, especificidade, precisão, valor preditivo positivo (VPP) e valor preditivo negativo (VPN) da EBUS-TBNA no diagnóstico de linfadenopatia granulomatosa, reacional e neoplásica. Em casos de granulomas inespecíficos, linfadenopatia reacional ou resultados inconclusivos, o diagnóstico definitivo foi estabelecido por meio de outros procedimentos diagnósticos ou ao longo de pelo menos 18 meses de acompanhamento. Resultados: Nos 58 pacientes incluídos, a EBUS-TBNA permitiu que se estabelecesse o diagnóstico de doença granulomatosa em 22 (38%), linfadenopatia reacional em 15 (26%), câncer em 8 (14%) e outras doenças em 3 (5%). Os resultados foram inconclusivos em 10 (17%), nos quais o diagnóstico foi feito por meio de outros procedimentos broncoscópicos, em 2 (20%), ou de procedimentos cirúrgicos, em 8 (80%). O diagnóstico final de linfadenopatia reacional foi feito em 12. Destes, 11 (92%) receberam confirmação diagnóstica durante o acompanhamento e 1 (8%), por meio de mediastinoscopia. Em outros 3, o diagnóstico final foi sarcoidose ou neoplasia. Para o diagnóstico de doença granulomatosa, câncer e linfadenopatia reacional, a EBUS-TBNA apresentou sensibilidade de 73%, 68% e 92%, respectivamente; especificidade de 100%, 100% e 93%, respectivamente; precisão de 86%, 93% e 93%, respectivamente; VPP de 100%, 100% e 80%, respectivamente; VPN de 78%, 92% e 98%, respectivamente. Conclusões: Em pacientes não neoplásicos, doenças granulomatosas e linfadenopatia reacional parecem ser causas comuns de LI isolada. A EBUS-TBNA apresenta resultados promissores como procedimento diagnóstico minimamente invasivo de primeira linha. Os resultados obtidos pela EBUS-TBNA podem ser otimizados pelos achados clínicos e radiológicos durante o acompanhamento ou pela comparação com os resultados de outros métodos broncoscópicos.

Fístula arteriovenosa renal pós-biópsia renal: relato de caso e revisão de literatura / Renal arteriovenous fistula after renal biopsy: a case report and literature review

Fístulas arteriovenosas (FAVs) renais adquiridas são raras, correspondendo a uma conexão anômala entre o sistema arterial e o sistema venoso. As FAVs renais se dividem em três grandes grupos: idiopáticas, congênitas e adquiridas, sendo as últimas as mais comuns. Atualmente, têm incidência aumentada em decorrência do crescente número de biópsias renais. Apesar de, atualmente, o procedimento de biópsia renal ser relativamente seguro, ele carrega como complicação a formação de FAV no território vascular renal. O tratamento de FAV renal é amplamente discutido na literatura e diversas modalidades terapêuticas podem ser aplicadas. Apresentamos um caso de FAV pós-biópsia renal que foi submetida a tratamento endovascular com sucesso mediante embolização com molas

Acquired renal arteriovenous fistulas (AVF) are rare conditions in which an anomalous connection arises between the arterial and venous systems. Renal AVFs can be classified into three main groups: idiopathic, congenital, and acquired, the last of which are the most common. Incidence has been increasing, due to the growing number of renal biopsies. Although the renal biopsy procedure is relatively safe nowadays, one possible complication is formation of an AVF in the renal vascular territory. Treatment of renal AVF is widely discussed in the literature and a variety of treatment methods can be employed. We report a case of arteriovenous fistula after renal biopsy that was successfully treated with endovascular coil embolization

Estudio patológico intraoperatorio en la cirugía tiroidea: ¿cuánto contribuye a la estrategia quirúrgica? / Intraoperative pathologic evaluation in thyroid surgery: how much does it contribute to surgical strategy?

Antecedentes: el papel del estudio patológico intraoperatorio (EPI) en cirugía tiroidea ha sido discutido largamente y es todavía motivo de controversia. Objetivo: estimar los resultados del EPI en el diagnóstico de malignidad, su relación con la biopsia por punción-aspiración preoperatoria con aguja fina (PAAF) y el estudio patológico diferido (EPD), así como su contribución al cambio en la estrategia quirúrgica en cirugía tiroidea. Material y métodos: revisión retrospectiva de las historias clínicas de 773 pacientes operados por patología tiroidea entre enero de 2014 y diciembre de 2015. En todos se efectuó EPI y EPD; a 686 (89%) pacientes también se les efectuó la biopsia por PAAF preoperatoria. Resultados: los resultados del EPI fueron benigno en 215 pacientes (27,8%), maligno en 419 (54,2%) y no definitivo en 139 (18,0%). Cuando estos resultados fueron comparados con la EPD se encontraron 19 casos (8,8%) de falsos negativos y 4 (0,95%) de falsos positivos. Considerando solo los resultados definitivos, el EPI tuvo sensibilidad 95%, especificidad 98%, valor predictivo positivo 99%, valor predictivo negativo 91% y exactitud 91%. Cuando se comparó el EPI con la PAAF preoperatoria, los valores de sensibilidad más bajos (44%) correspondieron a las categorías de Bethesda III y IV. El EPI influyó en la estrategia quirúrgica en 95 pacientes (12,28%): en 53 (6,8%), la hemitiroidectomía cambió a tiroidectomía total; en 37 (4,8%), el diagnóstico de metástasis ganglionares permitió realizar un vaciamiento modificado de cuello, y en 5 (0,6%) ocurrieron ambas situaciones. Conclusión: el EPI tuvo altos valores de utilidad diagnóstica cuando se compararon con el EPD. También se correlacionó con la PAAF preoperatoria, pero tuvo menos utilidad en las categorías Bethesda III y IV. El EPI contribuyó a cambiar la decisión de técnica quirúrgica en un grupo de pacientes y evitar una segunda operación.

Background: the role of intraoperative pathologic evaluation (IPE) in thyroid surgery has largely been discussed and it is still controversial. Objective: to estimate the results of IPE in diagnosis of malignancy, its correlation with preoperative fine needle aspiration (FNA) biopsy and permanent pathologic evaluation (PPE), and its contribution to change surgical strategy in thyroid surgery. Materials and methods: retrospective chart review of 773 patients operated on for thyroid disease between January 2014 and December 2015. All patients underwent IPE and PPE; 686 (89%) patients had also preoperative FNA biopsy. Results: IPE resulted benign in 215 patients (27.8%), malignant in 419 (54.2%) and non definitive in 139 (18.0%). When these results were compared with PPE, 19 cases were false negative (8.8%) and 4 false positive (0.95). Considering only definitive results, IPE had sensitivity 95%, specificity 98%, positive predictive value 99%, negative predictive value 91% and accuracy 91%. When IPE was compared with preoperative FNA biopsy, lowest values of sensitivity (44%) corresponded with Bethesda categories III and IV. IPE influenced surgical strategy in 95 patients (12.28%): in 53 (6.8%) hemithyroidectomy changed to total thyroidectomy, in 37 (4.8%) lymph node metastases diagnosis allowed to perform modified neck dissection, and in 5 (0.6%) both situations occurred. Conclusion: IPE had high values of diagnostic utility when compared with PPE. It also correlated with preoperative FNA biopsy, but had less utility in Bethesda categories III and IV. IPE contributed to change surgical technical decision in a subset of patients and avoid a second operation.

O estudo da ressonância magnética com difusão na avaliação da resposta à quimioterapia neoadjuvante para pacientes com câncer de mama / Early prediction of pathological response using MR diffusion weighted imaging in patients with breast cancer submitted to neoadjuvant chemotherapy

Introdução: A Ressonância Magnética (RM) tem se mostrado eficaz na avaliação de resposta à quimioterapia neoadjuvante (QTN) para câncer de mama. A avaliação através do realce dinâmico do contraste (DCE) é a ferramenta mais utilizada na RM para este propósito, porém a aplicação das imagens ponderadas em difusão (DWI) tem recebido especial interesse na atualidade. As sequências em difusão avaliam a mobilidade de moléculas de água no tecido, através do valor do coeficiente aparente de difusão (ADC). Desta forma, após o início de um tratamento quimioterápico, a redução do número de células no leito tumoral é estimada através do aumento do ADC nos exames de RM subsequentes, auxiliando na avaliação de resposta. Objetivo: avaliar o uso da RM-DWI na predição precoce de resposta patológica em pacientes com tumores de mama submetidos ao tratamento com quimioterapia neoadjuvante. Pacientes e métodos: Estudo prospectivo e unicêntrico, em que foram incluídas 62 pacientes com diagnóstico de. câncer de mama, elegíveis para quimioterapia neoadjuvante, admitidas no departamento de Mastologia do A.C.Camargo Cancer Center, no período de janeiro de 2015 a julho de 2016, após aprovação do projeto no comitê de ética em pesquisa e consentimento informado e esclarecido assinado pelas pacientes incluídas no projeto. As pacientes incluídas neste estudo realizaram três exames de RM: um antes (RM1), um após o primeiro ciclo (RM2) e outro após o último ciclo (RM3) de quimioterapia. As taxas de. resposta obtidas pela RM foram avaliadas, considerando a resposta patológica como padrão-ouro. Resultados: A idade das 62 pacientes variou de 27 a 65 anos, com mediana de 45,5 anos. O tamanho tumoral variou de 15 mm a 92 mm, com mediana de 40 mm. Houve predomínio do carcinoma invasivo do tipo não especial (85,5%). Vinte e dois (35,5%) tumores eram triplo negativos, 10 (16,1%) eram superexpressores de HER-2 e 30 (48%). eram subtipo Luminal B. Vinte e quatro (38,7%) tumores apresentaram resposta patológica completa (pCR). A variação do ADC (ADC) entre RM1 e RM2 foi mais elevada para o grupo pCR, com a mediana do ADC de 49% para o grupo pCR e 13% para o grupo não-pCR. Utilizando um ponto de corte de 25% para variação mínima do valor do ADC entre RM1 e RM2, o método apresentou sensibilidade de 83%, especificidade de 84%, VPP de 77%, VPN de 89% e acurácia de 84%. Não houve variação significativa das maiores dimensões tumorais entre a RM1 e RM2. Conclusão: A variação do ADC após o primeiro ciclo de QTN em pacientes com câncer de mama localmente avançado correlacionou-se bem com a taxa de resposta patológica tumoral. Houve um significativo aumento do ADC precedendo a redução da dimensão tumoral. O método é capaz de discriminar com boa. acurácia, logo após o primeiro ciclo, respondedoras de não respondedoras ao tratamento, quando há uma variação mínima de 25% do seu valor

INTRODUCTION: Magnetic Resonance Imaging (MRI) has been shown to be effective in evaluating the response to neoadjuvant chemotherapy (NCT) for breast cancer. Dynamic contrast enhancement (DCE) evaluation is the most used tool in MRI for this purpose, but the application of diffusion weighted images (DWI) has received special interest in the present time. The diffusion sequences evaluate the mobility of water molecules in the tissue, through the value of the apparent diffusion coefficient (ADC). Thus, after the introduction of a chemotherapeutic treatment, the reduction of the number of cells in the tumor bed is estimated by increasing the ADC in the subsequent MR exams, aiding in the evaluation of response. PURPOSE: to evaluate the use of MR-DWI in the early prediction of pathological response in patients with breast tumors submitted to treatment with neoadjuvant chemotherapy. PATIENTS AND METHODS: A prospective and unicentric study was carried out in which 62 patients undergoing NCT admitted in the department of Mastology, were enrolled in the diagnosis of breast cancer, from January 2015 to July 2016. The patients included in this study performed three MR imagings: one before (MR1), one after the first cycle (MR2) and another after the last cycle (MR3) of chemotherapy. The response rates obtained by MR imaging were evaluated, considering the pathological response as gold standard. RESULTS: The 62 patients ranged from 27 to 65 years, with a median age of 45.5 years. The tumor size ranged from 15 to 92 mm, with a median of 40 mm. There was a predominance of invasive carcinoma of no special type (85.5%). Twenty-two (35.5%) tumors were triple negative, 10 (16.1%) were HER-2 overexpression and 30 (48%) were luminal B. Twenty-four (38.7%) tumors presented complete pathological response (pCR). The percent ADC value increase between MR1 and MR2 was higher for the pCR group, with the median ADC of 49% for the pCR group and 13% for the nonpCR group. Using a cut-off point of 25% for minimum increase of the ADC value between MR1 and MR2, the method had a sensitivity of 83%, specificity of 84%, VPP of 77%, NPV of 89% and accuracy of 84% in early prediction of responder to nonresponder to NQT. CONCLUSION: The ADC variation after the first cycle of NQT in patients with locally advanced breast cancer correlated well with the rate of tumor pathological response. There was a significant increase of the ADC value preceding the reduction of the tumor dimension measured with DCE MR images. DWI is able to discriminate with a good accuracy, shortly after the first cycle, non-responder from responders to treatment when there is a minimum variation of 25% of its value

Effect of testicular puncture biopsy on the success rate of microdissection testicular sperm extraction for idiopathic non-obstructive azoospermia / 北京大学学报(医学版)

OBJECTIVE@#To explore the predictive effect of testicular puncture biopsy and the biopsy results on the success rate of microdissection testicular sperm extraction (micro-TESE) in patients with idiopathic non-obstructive azoospermia.@*METHODS@#We retrospectively evaluated the micro-TESE performance in patients with idiopathic non-obstructive azoospermia (NOA) referred to the Reproductive Medicine Center of Peking University Third Hospital between January 2012 and August 2017. We discussed whether to take the testicular biopsy and testicular biopsy results, including the intraoperative microscopic examination and postoperative pathology findings, could predict the success rate of the late micro-TESE.@*RESULTS@#There were 237 patients who were diagnosed as idiopathic NOA and received micro-TESE involved in the study and the total sperm retrieve rate was 25.7%. In 103 patients without testicular biopsy and 134 patients with preoperative testicular biopsy, the sperm retrieve rate was 26.2% and 25.4%, respectively. And there was no significant difference between the two groups. The testicular volume and serum follicle stimulating hormone levels of the two groups were (4.3±1.4) mL vs.(8.5±2.4) mL and (36.1±5.2) IU/L vs.(26.1±3.5) IU/L, respectively. Compared to the patients with preoperative testicular biopsy, the group of patients without testicular biopsy had a much smaller test volume and higher serum follicle stimulating hormone and the difference between the two groups was statistically significant. For the patients who were found with a small amount of sperm in both intraoperative microscopic examination and postoperative pathological examination, the sperm retrieve rate was 100% (7/7). And for the patients who were only found with sperm in intraoperative microscopic examination or postoperative pathology examination, the sperm retrieve rate (SRR) was 47.2% (17/36). For the patients who could be not found with sperm in both intraoperative microscopic examination and postoperative pathological examination, the SRR was only 11% (10/91). The difference between the groups was statistically significant.@*CONCLUSION@#Idiopathic non-obstructive azoospermia patients with smaller testicular volume still have a chance to be found with sperm by micro-TESE. The testicular biopsy results, including intraoperative microscopic examination and postoperative pathological findings, have predictive effect on the SRR for late micro-TESE. The patient who could not be found with sperm in both intraoperative microscopic examination and postoperative pathological examination have a small chance of success in micro-TESE.

Sensibilidad y especificidad de la punción aspirativa, con aguja fina, de tumores de glándulas salivales mayores en el Hospital Oncológico María Curie / 2 SENSIBILITY AND SPECIFICITY WITH FINE NEEDLE ASPIRATION OF MAJOR SALIVARY GLANDS TUMORS

Los tumores de glándulas salivales son una causa frecuente de consulta en servicios de cabeza y cuello. Para arribar a diagnostico es necesario realizar estudios por imágenes, citológicos a través de la punción aspirativa con aguja fina (PAAF) y anatomía patológica. Objetivo: Evaluar la eficacia de la PAAF en los tumores de glándulas salivales mayores en nuestro medio, teniendo en cuenta los beneficios de ésta y el avance en las técnicas de diagnóstico por imágenes; ¿Estas podrían reemplazar al método citológico? Métodos: Estudio descriptivo y retrospectivo en base a las historias clínicas de los pacientes con tumores de glándulas salivales mayores a quienes se les realizo PAAF, y que posteriormente fueron sometidos a cirugía. Resultados: Se revisaron 113 historias clínicas de pacientes con tumores de glándulas salivales entre Junio de 2010 y Febrero de 2017, se excluyeron 37 (32,7%), quedando incluídos en este estudio 76 pacientes (67,3%). La PAAF hizo diagnóstico en un 84,2% de los pacientes. Sensibilidad del 93% y especificidad del 75%. Conclusión: La PAAF es una prueba sencilla, pero de utilidad limitada en el diagnóstico de tumores de glándulas salivales mayores en nuestro caso debido a la baja especificidad. Es útil para planificar la terapéutica cuando se sospecha la presencia de un tumor maligno, en especial para poder comunicar al paciente y la familia la conducta terapéutica, incluso tomar decisión en pacientes con alto riesgo quirúrgico

Salivary gland tumors are a frequent cause of consultation in head and neck services. In order to arrive at the diagnosis, it is necessary to perform imaging, cytological studies through fine needle aspiration (FNA) and pathological anatomy. Objective: To evaluate the efficacy of FNA in major salivary gland tumors in our setting, taking into account the benefits of FNA and progress in diagnostic imaging techniques; could they replace the cytological method? Methods: Descriptive and retrospective study based on the medical records of patients with tumors of the major salivary glands who underwent FNA and who were subsequently submitted to surgical intra and postperative biopsy. Results: A total of 113 clinical records of patients with salivary gland tumors were reviewed between June 2010 and February 2017, 37 (32.7%) were excluded, and 76 patients (67.3%) were included in the study. The FNA was diagnosed in 84.2% of the patients. Sensibility was 93% and specificity 75%. Conclusion: FNA is a simple test, but of limited utility in the diagnosis of tumors of the major salivary glands in our case due to the low specificity. It is useful to plan the therapeutics when the presence of a malignant tumor is suspected, especially to be able to communicate to the patient and the family the therapeutic behavior, even to make decision in patients with high surgical risk

Lateral decubitus position vs. lithotomy position: which is the best way to minimize patient's pain perception during transrectal prostate biopsy?

ABSTRACT Introduction Considering the distinctive nature in terms of psychological stress and anal tone of position which is generally selected between lithotomy and left lateral decubitus (LLD), we postulated its effect on pain perception during biopsy, and investigated their association. Materials and Methods A prospective study for comparison of two biopsy positions which were perform in a different working day was conducted for 208 men (lithotomy position=86, LLD=122). The decision on the position was made solely based on the patient’s preference for the biopsy day, and all procedures were performed according to the identical protocol (12-core biopsy with intrarectal lidocaine gel), probe, and needle. The maximal degree of pain during the entire process was assessed using a visual analogue scale (VAS), immediately after biopsy. After propensity matching, a total of 152 patients were finally selected (lithotomy group=76, LLD=76), then peri-biopsy parameters were compared. Results Between groups, no differences were observed across all variables including age, obesity, prostate volume, serum PSA, international prostate symptom score, and cancer detection rate, except mean (±standard deviation) VAS score (3.89±2.01 vs. 4.58±2.22, p=0.049). VAS score showed significant association solely with patient’s position (Pearson’s coefficient=-0.165, p=0.042). In multiple linear regression models regarding the effect of clinical variables on VAS score, patient position was a single independent predictor favoring lithotomy position to decrease perceived pain (B=-0.928, p=0.024). Conclusions These data suggest lithotomy position as a proper way to perform transrectal prostate biopsy with routine use of topical lidocaine gel in comparison with conventional LLD position.

Sensitivity of computed tomography-guided transthoracic biopsies in a Nigerian tertiary institution

Introduction: The indications for open biopsies for intrathoracic lesions have become almost negligible. This development was made possible by less invasive maneuvers such as computed tomography-guided (CT-guided) biopsy, thoracoscopy or video-assisted thoracoscopy, and bronchoscopy. CT-guided percutaneous lung biopsy was first reported in 1976. Aim of Study: The aim of the study is to report our experience with CT-guided transthoracic biopsy. Materials and Methods: Patients with clinical and radiological evidence of intrathoracic mass were counseled and consent obtained for the procedure. They were positioned in the gantry, either supine or prone. A scout scan of the entire chest was taken at 5 mm intervals. The procedure was carried out by the consultants and senior registrar. Following visualization of the lesion, its position in terms of depth and distance from the midline was measured with the machine in centimeter to determine the point of insertion of the trucut needle (14­18-G). The presumed site of the lesion was indicated with a metallic object held in place with two to three strips of plasters after cleaning the site with Povidone-iodine. After insertion, repeat scans were performed to confirm that the needle was within the mass. A minimum of 3 core cuts was taken to be certain that the samples were representative. The results were analyzed by the determination of means and percentages. Results: Twenty-six patients underwent this procedure between 2011 and 2015. There were 15 males and 11 females (M:F = 1.4:1). The age range was between 30 and 99 years with a mean of 55 years. Histological diagnosis was obtained in 24 of the patients giving sensitivity of 92.3%. There were 3 mild complications giving a rate of 11.5%. The complications included a case of mild hemoptysis and two patients who had mild pneumothoraces which did not require tube thoracostomy. Conclusion: CT-guided biopsy is a reliable procedure for obtaining deep-seated intrathoracic biopsies with high sensitivity and minimal complication rate

Development of a multifunctional needle for percutaneous heart biopsy and cell therapy. a technical note

Abstract Validation of transendocardial injection as a method for delivering therapeutic agents to the diseased heart is increasing. Puncture heart biopsies should re-emerge as a possible alternative method to allow access to the myocardium and implantable biomaterial for cell therapy. Therefore, this work aims to present a percutaneous puncture device for biopsy and intramyocardial biomaterial injection, standardize the technique and attest to the safety of the method. The adaptation consists of creating myocardial microlesions that allow for better fixation of stem cells. The objective of this technical note covers only the development of the needle and the histological quality of the biopsies. It has not been used in humans yet.

Mamoplastía excisional en el manejo del tumor Filodes / Excisional mammoplasty in the management of the tumor Filodes

Se presenta el siguiente estudio retrospectivo-descriptivo en un lapso de 16 años de pacientes que consultaron con diagnóstico de tumor Filodes al departamento de Cirugía del Hospital General San Juan de Dios. Todas las pacientes recibieron imagen y diagnóstico preoperatorio con Mamografía, Ultrasonido, biopsia aguja gruesa y algunos casos con biopsia incisional o excisional...

The present following descriptive retrospective study over a period of 16 years of patients admitted with a diagnosis of phylldes tumor to the departament of surgery of the Hospital General San Juan de Dios.All patients received preoperative image diagnostic with mammography ultrasound biopsy core needlebiopsy anxd cases with incision or excision biopsy...

Seguridad de la aplicación intravenosa del cigb-300 en pacientes con hemopatías malignas. Estudio EHPMA / Red blood cell antigens and antibodies in patients awaiting renal transplantation

Introducción: el CIGB-300 es un péptido sintético capaz de producir apoptosis en células tumorales. Objetivos: explorar la seguridad del CIGB-300 administrado por vía intravenosa en pacientes con hemopatías malignas. Metodología : se realizó un ensayo clínico fase I, multicéntrico, no aleatorizado, adaptativo, con un solo grupo de tratamiento y escalado de dosis en el mismo paciente (Registro No. 05.013.12.B). Los eventos adversos se clasificaron según la versión 4.03 de Terminología de los Criterios Comunes para Eventos Adversos. Se seleccionaron pacientes con edad igual o mayor a 18 años, no candidatos a trasplante de médula ósea, con leucemias agudas refractarias o en recaída, leucemia aguda mielobástica del anciano y síndromes mielodisplásticos con exceso de blastos, que tuvieron ECOG ≤ 3 y aceptaron participar en la investigación. Se consideraron como criterios de exclusión: la leucemia promielocítica, enfermedades crónicas descompensadas, antecedentes alérgicos graves, embarazo, puerperio y lactancia. Para las variables cuantitativas, se estimaron medidas de tendencia central y para las cualitativas la distribución de frecuencias. Resultados: de 10 pacientes incluidos, 6 realizaron el tratamiento con los cinco niveles de dosis. Se presentaron 94 tipos de eventos adversos, la mayoría de carácter sistémico, con 619 notificaciones. El prurito y el eritema localizados fueron los eventos más comunes, seguidos de la hipertensión arterial. Los eventos se presentaron con mayor frecuencia el primer día de cada ciclo y no se detectó su aumento al incrementar la dosis del producto. El 87,7 por ciento se consideraron eventos leves y el 61,6 por ciento con causalidad muy probable. Se presentaron 15 eventos adversos graves, pero solo uno fue relacionado con la administración del CIGB 300. Conclusiones: la administración intravenosa del CIGB-300 fue segura y bien tolerada. El escalado de dosis no aumentó la toxicidad del producto(AU)

Introduction: CIGB-300 is a synthetic peptide capable of producing apoptosis in tumor cells. Objectives: To explore the safety of CIGB-300 administered intravenously in patients with hematological malignancies (Registry No. 05.013.12.B). Methodology : A multicenter, non-randomized, adaptive, with an only treatment group (intravenous administration of the investigational product and dose escalation in the same patient), phase I clinical trial was conducted. Adverse events were classified according to the version 4.03 of Common Terminology Criteria for Adverse Events . Patients aged 18 years or older were selected, not candidates for bone marrow transplantation, with refractory or relapsed acute leukemias, acute myeloblastic leukemia of elderly, and myelodysplastic syndromes with blast excess, who had ECOG ≤ 3 and agreed to participate in the investigation. We considered as exclusion criteria: acute promyelocytic leukemia, decompensated chronic diseases, severe allergic history, pregnancy, postpartum and breastfeeding. For quantitative variables, measures of central tendency and qualitative distribution of frequencies were estimated. Results: Of 10 patients included 6 received treatment with five dose levels. Ninety four types of adverse events were present, most systemic, with 619 notifications. Localized itching and rash were the most common events, followed by high blood pressure. The events occurred more frequently on the first day of each cycle and no increase was detected when the dose of the product was rised. Minor events were 87,7 percent and 61,6 percent with probable causality. Fifteen serious adverse events occurred, but only one was related to the administration of CIGB 300. Conclusions: Intravenous administration of CIGB-300 was safe and well tolerated. Dose escalation did not increase the toxicity of the product(AU)

Incidence of sepsis following transrectal ultrasound guided prostate biopsy at a tertiary-care medical center in Lebanon

ABSTRACT Background Urosepsis is a rare but life-threatening complication following transrectal ultrasound (TRUS) guided needle prostate biopsy. Despite the technological and pharmacological improvements, the problem of bacterial urosepsis after prostate biopsy remains. A strategy for preventing urosepsis following TRUS prostate biopsy in areas with high prevalence of resistant strains or patients presenting risk factors is lacking. Objectives The aim of this study was to assess the prevalence of urosepsis, as well its predictors, following TRUS guided needle biopsy of the prostate in a tertiary care medical center in Lebanon. Materials and Methods We carried out a retrospective study on all patients who underwent TRUS prostate biopsy at the American University of Beirut Medical Center between January 1, 2011 and June 31, 2013. Patients’ hospital charts were reviewed. Data collected included demographic information, pre-procedure disease specific information, as well as post-procedure information. Predictors of urosepsis following TRUS were assessed. Results In total, 265 patients were included in this study, where the prevalence of urosepsis following TRUS prostate biopsy was found to be 9.4%. The significant independent predictors of urosepsis were found to be: age with an OR=0.93 (95% CI: 0.88–1.00, p-value=0.03), and hypertension comorbidity with an OR=3.25 (95% CI: 1.19–8.85, p-value=0.02). Conclusion We found a high prevalence of urosepsis among patients who have undergone TRUS prostate biopsy, and identified two significant risk factors. The results of this study highlight the importance of implementing strategies for prevention of urosepsis following TRUS prostate biopsy.

LIVER BIOPSY: IMPORTANCE OF SPECIMEN SIZE IN THE DIAGNOSIS AND STAGING OF CHRONIC VIRAL HEPATITIS

Liver biopsy is the gold standard method for the grading and staging of chronic viral hepatitis, but optimal biopsy specimen size remains controversial. The aim of this study was to evaluate the quality of liver specimen (number of portal tracts) and to evaluate the impact of the number of portal tracts in the staging of chronic hepatitis. Material and Methods: 468 liver biopsies from consecutive patients with hepatitis C virus and hepatitis B virus infection from 2009 to 2010 were evaluated. Results: The length of fragment was less than 10 mm in 43 cases (9.3%), between 10 and 14 mm in 114 (24.3%), and ≥ 15 mm in 311 (64.4%); of these, in 39 (8.3%) cases were ≥ 20 mm. The mean representation of portal tracts was 17.6 ± 2.1 (5-40); in specimens ≥ 15 mm the mean portal tract was 13.5 ± 4.7 and in cases ≤ 15 mm was 11.4 ± 5.0 (p = 0.002). Cases with less than 11 portal tracts were associated with F3, and cases with 11 or more portal tracts with F2 (p = 0.001). Conclusion: this study demonstrated the good quality of liver biopsy and a relationship between the macroscopic size of the fragment and the number of portal tracts.

The efficacy of duration of prophylactic antibiotics in transrectal ultrasound guided prostate biopsy

ABSTRACT Introduction: We aimed to evaluate the efficacy of the duration of prophylactic antibiotic administration in patients undergoing transrectal ultrasound (TRUS) guided biopsy. Material and Methods: A total of 367 patients undergoing a prostate biopsy between September 2007 and June 2009 was reviewed retrospectively and divided into 2 groups according to prophilaxy: oral ciprofloxacin (750 mg every 12 hours) for 3 or more days in Group-1 and single day in Group-2. Demographic characteristics of patients, symptoms, PSA values, IPSS scores, prostate sizes, pathologic results and complications were compared between the groups. Results: The mean age of all patients was 63.92 years and the mean PSA was 13.61ng/ dL. The pre-biopsy mean IPSS score was 12.47 and mean prostate volume 52.53 mL. For 78.2% of patients the current biopsy was their first biopsy. Cancer detection rate was 24.2%. Fever was observed in 3 (1.2%) patients in Group-1 and 5 (4.0%) patients in Group-2. Local infections occurred in 2 (0.8%) and 1 (0.8%) patients respectively in Groups 1 and 2. Acute prostatitis was observed in only 1 (0.8%) patient in Group-2. Accepted after revision: None of the patients developed septicemia or other serious infection. There was no statistically significant difference in terms of fever, local infections (epididimitis, orchitis, etc.) and acute prostatitis. Conclusions: In a selected patient population single dose prophylaxis with ciprofloxacin can be safely administered compared to other regimens of 3 or more days. Increasing the duration of antibiotic prophylaxis does not decrease infectious complications.

Local anesthesia type affects cancer detection rate in transrectal ultrasound guided prostate biopsy

ABSTRACT Purpose: Studies about the anesthesia techniques during transrectal ultrasound guided prostate biopsy (TRUS-Bx) are usually focused on pain relief. Although patients' tolerance is an important issue in TRUS-Bx, cancer detection rate (CDR) must not be ignored. In this study, we compared the impact of intrarectal lidocaine gel anesthesia (IRLA) and periprostatic nerve blockade (PNB) techniques on CDR. Materials and Methods: A total of 422 patients underwent 10 core-TRUS-Bx because of elevated serum prostate specific antigen (PSA) level (>2.5ng/mL) and/or suspicious digital rectal examination findings. Patients were divided into two groups according to the applied anesthesia technique: IRLA group and PNB group. Age, serum PSA level, prostate volume, visual analogue scale (VAS) score and CDR were recorded and compared statistically with chi square and unpaired t-tests. Results: Of the patients 126/422 (29.9%) underwent TRUS-Bx by using IRLA whereas 296/422 (70.1 %) by PNB technique. The mean, age, serum PSA level and prostate volume were similar between the two groups. CDR was 19.8% and 25.4% in IRLA and PNB groups, respectively (p=0.001). The mean VAS score of the PNB group (1.84±0.89) was significantly lower than that for IRLA group (3.62±1.06) (p=0.001). Conclusions: Our results revealed that PNB is superior to IRLA in terms of CDR. Further studies are required to confirm our findings.

Diagnostic value of endobronchial ultrasound-guided transbronchial needle aspiration in various lung diseases / Valor diagnóstico da punção aspirativa por agulha guiada por ultrassom endobrônquico em diferentes doenças pulmonares

Objective: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a new method for the diagnosis and staging of lung disease, and its use is increasing worldwide. It has been used as a means of diagnosing lung cancer in its initial stages, and there are data supporting its use for the diagnosis of benign lung disease. The aim of this study was to share our experience with EBUS-TBNA and discuss its diagnostic value.Methods: We retrospectively analyzed the results related to 159 patients who underwent EBUS-TBNA at our pulmonary medicine clinic between 2010 and 2013. We recorded the location and size of lymph nodes seen during EBUS. Lymph nodes that appeared to be affected on EBUS were sampled at least twice. We recorded the diagnostic results of EBUS-TBNA and (for cases in which EBUS-TBNA yielded an inconclusive diagnosis) the final diagnoses after further investigation and follow-up.Results: We evaluated 159 patients, of whom 89 (56%) were male and 70 (44%) were female. The mean age was 54.6 ± 14.2 years among the male patients and 51.9 ± 11.3 years among the female patients. Of the 159 patients evaluated, 115 (84%) were correctly diagnosed by EBUS. The diagnostic accuracy of EBUS-TBNA was 83% for benign granulomatous diseases and 77% for malignant diseases.Conclusions: The diagnostic value of EBUS-TBNA is also high for benign pathologies, such as sarcoidosis and tuberculosis. In patients with mediastinal disorders, the use of EBUS-TBNA should be encouraged, primarily because it markedly reduces the need for mediastinoscopy.

Objetivo: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA, punção aspirativa por agulha guiada por ultrassom endobrônquico) é um novo método para o diagnóstico e estadiamento das doenças pulmonares e seu uso está aumentando em todo o mundo. Ela tem sido utilizada como um método diagnóstico de câncer de pulmão em estágios iniciais, e há dados que apoiam sua utilização para o diagnóstico de doenças pulmonares benignas. O objetivo deste estudo foi compartilhar a nossa experiência com EBUS-TBNA e discutir seu valor diagnóstico.Métodos: Analisamos, retrospectivamente, os resultados relacionados a 159 pacientes submetidos a EBUS-TBNA em nossa clínica de medicina pulmonar entre 2010 e 2013. Registramos a localização e o tamanho dos linfonodos visualizados durante EBUS. Os linfonodos suspeitos durante o procedimento foram puncionados ao menos duas vezes. Foram registrados os resultados diagnósticos por EBUS-TBNA e, para os casos com diagnóstico indefinido após EBUS-TBNA, os diagnósticos finais após investigação aprofundada e acompanhamento.Resultados: Avaliamos 159 pacientes, dos quais 89 (56%) eram homens e 70 (44%) eram mulheres. As médias de idade foram de 54,6 ± 14,2 anos nos homens e de 51,9 ± 11,3 anos nas mulheres. Dos 159 pacientes avaliados, 115 (84%) foram diagnosticados corretamente por EBUS. A acurácia diagnóstica de EBUS-TBNA foi de 83% para doenças granulomatosas benignas e de 77% para doenças malignas.Conclusões: O valor diagnóstico de EBUS-TBNA também é alto para patologias benignas, como sarcoidose e tuberculose. Em pacientes com alterações no mediastino, o uso de EBUS-TBNA deve ser incentivado, principalmente devido à redução significativa da necessidade de mediastinoscopia.

The importance of breast elastography added to the BI-RADS® (5th edition) lexicon classification / A importância da elastografia mamária adicionada à classificação, segundo o léxico BI-RADS® (5ª edição)

SummaryObjective:the aim of this study was to investigate the addition of elastography to the BI-RADS® lexicon for the classification of breast lesions.Methods:a total of 955 consecutive patients who were subjected to breast percutaneous biopsy from January 2010 to December 2012 were retrospectively assessed. Overall, 26 patients who did not present with masses on conventional ultrasound were excluded. The patients were classified according to the fifth edition of the breast imaging and reporting data system (BI-RADS®) lexicon, which includes elastographic findings. The BI-RADS®classification is based on the same classification principles that have been suggested by the author, which classify lesions as soft, intermediate, or hard.Results:the addition of elastographic findings to the BI-RADS® lexicon improved the sensitivity (S), specificity (SP), and diagnostic accuracy (DA) of ultrasound in the assessment of breast lesions, which increased from 93.85, 72.07, and 76.64 to 95.90, 80.65, and 91.39%, respectively.Conclusion:these findings suggest that the addition of elastography to the BIRADS ® lexicon will improve the SP and DA of ultrasound in the screening of breast lesions.

ResumoObjetivo:investigar o impacto da adição da descoberta da elastografia das lesões mamárias à classificação segundo o léxico BI-RADS®.Métodos:estudo retrospectivo com 955 pacientes consecutivas, submetidas à biópsia mamária percutânea no período de janeiro de 2010 a dezembro de 2012. Foram excluídas 26 pacientes que apresentaram lesão não nodular ao ultrassom convencional. As lesões foram classificadas conforme proposta da 5ª edição do léxico BI-RADS®, que inclui os achados de elastografia. A classificação BI- -RADS® é baseada nos mesmos critérios propostos pelo autor, que classifica as lesões como macias, intermediárias e rígidas.Resultados:a adição dos achados da elastografia ao léxico BI-RADS® melhorou a sensibilidade (S), a especificidade (E) e a acurácia diagnóstica (AD) do ultrassom na avaliação das lesões mamárias, de 93.85, 72.07 e 76.64% para 95.90, 80.65 e 91.39%, respectivamente.Conclusão:os achados sugerem que a adição dos achados da elastografia ao léxico BI-RADS® pode melhorar a S, a E e a AD do ultrassom no rastreamento de lesões mamárias.