Percutaneous Core Biopsy Devices: A Detailed Review and Comparison of Different Needle Designs.

ABSTRACT: Percutaneous core-needle biopsy (PCNB) plays a growing and essential role in many medical specialties. Proper and effective use of various PCNB devices requires basic understanding of how they function. Current literature lacks a detailed overview and illustration of needle function and design differences, a potentially valuable reference for users ranging from early trainees to experts who are less familiar with certain devices. This pictorial aims to provide such an overview, using diagrams and magnified photographs to illustrate the intricate components of these devices. Following a brief historical review of biopsy needle technology for context, we emphasize distinctions in design between 2 major classes of PCNB devices (side- and end-cutting devices), focusing on practical implications for how each device is most effectively used. We believe a nuanced understanding of biopsy device function sheds light on certain lingering ambiguities in biopsy practice, such as the optimal needle gauge in organ biopsy, the benefits and risks associated with coaxial technique, the impact of needle selection and technique on bleeding, and the risk of unsuccessful sampling. In a subsequent pictorial, we will draw on the concepts presented here to illustrate examples of biopsy needle failure and how unrecognized needle failure can be an important and often preventable cause of increased biopsy risk and lower tissue yield.

Adult Medulloblastoma: Occurrence of a Rare Event.

Medulloblastoma is the most common type of aggressive pediatric primary brain malignancy. This case describes a 45-year-old Hispanic male with no significant past medical history who presented to the emergency department (ED) complaining of 15 days of 10/10 intractable headaches with one day of lightheadedness, confusion, and loss of balance. An urgent magnetic resonance imaging (MRI) of the brain revealed a 4.1 x 3.3 x 3.2 cm mass at the cerebellum, exerting a mass effect on the brainstem and mild tonsillar herniation. A pre-surgical physical exam revealed only a positive Babinski sign bilaterally with normal proprioception and cerebellar function. The intraoperative report concluded an undifferentiated neoplasm with a histological differential diagnosis of medulloblastoma, ependymoma, or other neuroepithelial neoplasms, suggesting a referral to a tertiary care center for further evaluation of the mass. Postsurgical complications included a severe vasogenic edema, causing obstructive hydrocephalus treated with frontal ventricular drainage, signs of meningitis treated with antibiotics, and hyponatremia. This case describes a rare occurrence of medulloblastoma in an adult patient, which required prompt diagnosis and urgent life-saving treatment.

Immunization Against Group B Streptococci vs. Intrapartum Antibiotic Prophylaxis in Peripartum Pregnant Women and their Neonates: A Review.

Group B streptococcus (GBS) is an organism that has an immense global impact on neonatal morbidity and mortality. GBS is known to colonize the gastrointestinal and genitourinary tracts of infected pregnant women. Transmission to the neonate is achieved during labor and delivery. Complications of neonatal infection include sepsis, meningitis, and pneumonia. Preventative measures are needed to reduce the disease burden. The current method of prophylaxis being utilized is intrapartum antibiotics. Though effective, it presents limitations that include a required, lengthy duration of treatment, increased antibiotic resistance, and lack of late-onset disease coverage. Recent studies are exploring alternative methods of prophylaxis such as vaccination. Vaccination provides coverage of both early and late-onset disease to infected women who are unable to complete the required four hours of antibiotic course intrapartum, women with resistance to antibiotic infections, and women delivering in resource-poor areas without access to antibiotics. An investigational CRM197 conjugated trivalent vaccine has shown a good immunogenicity profile against the three most prevalent serotypes. The vaccine induced antibodies freely cross the placenta and persist in a neonate for up to 90 days after birth. Additionally, the vaccine possesses a safety profile free of any serious systemic adverse effects and only mild pain at the injection site. Future studies should focus on investigating the effect of the vaccine on maternal rectovaginal acquisition and subsequent vaginal colonization, as well as the expansion of vaccine coverage to all 10 serotypes identified worldwide in order to facilitate its use in resource-poor areas of the world with inadequate antibiotic availability. If available, such a vaccine can serve as an effective supplement to current guidelines of antibiotic prophylaxis against GBS in peripartum women and their neonates.