Computed tomography-guided percutaneous core needle biopsy in pancreatic tumor diagnosis.

AIM: To evaluate the techniques, results, and complications related to computed tomography (CT)-guided percutaneous core needle biopsies of solid pancreatic lesions. METHODS: CT-guided percutaneous biopsies of solid pancreatic lesions performed at a cancer reference center between January 2012 and September 2013 were retrospectively analyzed. Biopsy material was collected with a 16-20 G Tru-Core needle (10-15 cm; Angiotech, Vancouver, CA) using a coaxial system and automatic biopsy gun. When direct access to the lesion was not possible, indirect (transgastric or transhepatic) access or hydrodissection and/or pneumodissection maneuvers were used. Characteristics of the patients, lesions, procedures, and histologic results were recorded using a standardized form. RESULTS: A total of 103 procedures included in the study were performed on patients with a mean age of 64.8 year (range: 39-94 year). The mean size of the pancreatic lesions was 45.5 mm (range: 15-195 mm). Most (75/103, 72.8%) procedures were performed via direct access, though hydrodissection and/or pneumodissection were used in 22.2% (23/103) of cases and indirect transhepatic or transgastric access was used in 4.8% (5/103) of cases. Histologic analysis was performed on all biopsies, and diagnoses were conclusive in 98.1% (101/103) of cases, confirming 3.9% (4/103) of tumors were benign and 94.2% (97/103) were malignant; results were atypical in 1.9% (2/103) of cases, requiring a repeat biopsy to diagnose a neuroendocrine tumor, and surgical resection to confirm a primary adenocarcinoma. Only mild/moderate complications were observed in 9/103 patients (8.7%), and they were more commonly associated with biopsies of lesions located in the head/uncinate process (n = 8), than of those located in the body/tail (n = 1) of the pancreas, but this difference was not significant. CONCLUSION: CT-guided biopsy of a pancreatic lesion is a safe procedure with a high success rate, and is an excellent option for minimally invasive diagnosis.

Structural and ultrastructural study of the anterior portion of the nasal septum and inferior nasal concha.

We used scanning electron microscopy to study and compare the histologic and ultrastructural aspects of the mucosa of the anterior portion of the septum (APS) and the anterior portion of the inferior concha (APINC) in 10 healthy adults and 10 cadavers. We found that (1) in most cases, the types of epithelium were generally the same in both areas--pseudostratified cylindrical ciliated epithelium with goblet cells (respiratory epithelium), stratified cuboidal epithelium, and stratified squamous nonkeratinized epithelium; (2) the APINC had more respiratory epithelium than the APS; (3) the APS had more squamous epithelium than the APINC; (4) the basement membrane of the APINC was thicker than that of the APS; (5) moderate chronic inflammatory infiltrate was more common in the APINC, and mild infiltrate was more common in the APS; and (6) the APINC had more mucous glands and the APS had more serous glands.

Necessidade discutível de esvaziamento uterino de rotina em abortamento espontâneo em clínica privada / Discussible need of routine uterine emptying in spontaneous abortion in private clinic

Os autores apresentam 410 casos de abortamento espontâneos em clínica de esterilidade conjugal, dos quais apenas 32 (7,8//) necessitaram esvaziamento uterino cirúrgico. Destes 9 (nove) obedecendo protocolo da fertilizaçäo assistida com transferência de embriäo, e tendo evoluído para o abortamento. Oito (n=8) por suspeita de manuseio ginecológico, cinco (n=5) por suspeita de mola hidatiforme, nove (n=9) por fatores psicossomáticos envolvidos e apenas um (n=1) devido a sangramenteo uterino abundante. As eliminaçöes espontâneas (n=378) e "loquiaçöes" ocorreram em prazo máximo de 4 semanas näo ocorrendo qualquer complicaçäo neste grupo, levando em consideraçäo que näo houve exame ginecológico em momento algum. A administraçäo de medicamentos estro-progestativos e uterolíticos durante a gestaçäo näo mudaram a evoluçäo. Discutem os autores a necessidade de dosagem de beta-HCG e exames ecográficos frequentes, principalmente visando excluir neoplasia trofoblástica gestacional, e além disso, de boa relaçäo médico-paciente. Acreditam estarem evitando assim "stress" físico local, emocional e complicaçöes dos fatores de abortamentos espontâneos de repetiçäo ou näo pré-existentes. Resta considerar os problemas em adaptar-se esta conduta ás condiçöes dos serviços-escolas ou ambulatórios ginecológicos gerais. Neles, o atendimento médico tem características peculiares quanto a relato médico-paciente, além dos problemas nas repetiçöes de exames instrumentais e laboratoriais. Em trabalho em evoluçäo em nosso ambulatório-escola discute-se estes aspectos