Treatment of postbiopsy pneumothorax with a self-contained pneumothorax treatment device.

PURPOSE: To evaluate the usefulness of a self-contained pneumothorax treatment device, in which a catheter and a one-way valve compose a single unit, in cases of postbiopsy pneumothorax. MATERIALS AND METHODS: Twenty-one patients underwent placement of the device to drain a postbiopsy pneumothorax. Treatment was considered successful when no therapy other than the device was needed. RESULTS: Treatment was successful in 16 (76%) of the 21 patients. Causes of treatment failure were dislodgment of the device (n = 3), malfunction of the device (n = 1), and a persistent air leak that led to pneumothorax recurrence after removal of the device (n = 1). Eight patients (38%) experienced problems after insertion of the device: The device dislodged in seven patients and malfunctioned in one patient. These problems led to treatment failure in four patients (see above). In the remaining four, further treatment after device dislodgment was not required. CONCLUSION: Treatment with the self-contained pneumothorax treatment device shows promise. Modifications to the device may alleviate technical problems and insertion difficulties.

Percutaneous abscess drainage: current applications for critically ill patients.

Radiologically guided percutaneous abscess drainage (PAD) was first reported in 1977. Since this time, technological advances in imaging, improved catheter technology, and increased experience with the procedure have resulted in a tremendous expansion of the indications for PAD. This procedure currently has applications in nearly every organ system of the body. These changes have also contributed to improved success rates, with concurrent minimization of procedure-related complications. The advantages of PAD include simple, rapid performance; feasibility of bedside intensive care unit (ICU) performance; safety; avoidance of general anesthesia; and well-documented efficacy. This procedure has now become well entrenched in clinical medicine and probably ranks with the development of effective antibiotics as the most significant improvement in the treatment of abscesses in the past century. PAD is ideally suited for the treatment of critically ill ICU patients. We discuss technical developments over the past 15 years; general principles of patient preparation and catheters are also reviewed. Current applications of PAD in each organ system are discussed.

Ultrasound guided biopsy of nonpalpable and difficult to palpate thyroid masses.

We reviewed our experience with ultrasound-guided biopsies of masses of the thyroid gland that were either nonpalpable or difficult to localize by palpation to evaluate the technique and correlate the results. Thirty-two biopsies were performed upon 25 patients whose clinical presentations were palpable nodule (six patients), throat discomfort (two patients), postpartial thyroidectomy follow-up evaluation (two patients), incidental discovery of a mass--by ultrasound of the neck (two patients), roentgenogram of the chest (two patients), computed tomography of the chest (one patient) and during tracheostomy placement (one patient). Other presentations were eliminate infection (one patient), odynophagia (one patient), hoarseness (one patient), cold nodule on a nuclear medicine study (one patient), hyperparathyroidism (one patient), rule out metastasis from carcinoma of the colon (one patient), persistent cough (one patient), enlarged thyroid gland (one patient) or family history of carcinoma of the thyroid gland (one patient). Fifteen patients had nuclear medicine studies showing either a cold nodule (ten patients), multinodular goiter (one patient), normal examination (two patients), hot nodule (one patient) or no thyroid gland activity (one patient). The ultrasound examinations showed either a hypoechoic nodule (25 patients), inhomogeneous or mixed echogenic nodule (six patients) or a hyperechoic nodule with hypoechoic rim (one patient). The nodules ranged in size from 3 milliliters to 7 centimeters. Twenty-six lesions were less than 3 centimeters in diameter; of the other six, four were substernal goiters. Six patients had a previous nondiagnostic biopsy directed by palpation only. Biopsy was performed using real-time ultrasound guidance with various needles. One patient had a small hematoma, which was the only complication in the study. The results of the biopsies were diagnostic in 26 of 32 patients. The final diagnosis was benign follicular cells (ten patients), adenomatous nodule (seven patients), follicular neoplasm (three patients), colloid cyst (two patients), aspergillus (two patients), fibrosis (one patient) and papillary carcinoma (one patient). Six of the biopsies yielded unsatisfactory specimens. One of the patients with a diagnosis of benign follicular cells on biopsy had a follicular carcinoma after surgical pathologic factors were obtained; that was the only false-negative result. We conclude that ultrasound-guided biopsy of the thyroid is a safe and useful method of evaluating nonpalpable and difficult to palpate thyroid masses.

Efficacy and morbidity of water soluble and oil-based myelography. Study compares both methods in 314 patients.

Retrospective studies were carried out on 314 patients who underwent oil-based or water-soluble myelography between July 1981 and July 1982 in two community hospitals. Morbidities and efficacies were compared and it was concluded that metrizamide myelography is a preferable method.