ABSTRACT
BACKGROUND/AIMS: Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) cytology of adrenal masses helps in etiological diagnosis. The aim of this study was to evaluate the diagnostic yield of EUS-FNA of adrenal masses in cases where other imaging methods failed and/or were not feasible. METHODS: Twenty-one consecutive patients with adrenal masses, in whom adrenal FNA was performed because conventional imaging modalities failed and/or were not feasible, were prospectively evaluated over a period of 3 years. RESULTS: Of the 21 patients (mean age, 56±12.2 years; male:female ratio, 2:1), 12 had pyrexia of unknown origin and the other nine underwent evaluation for metastasis. The median lesion size was 2.4×1.6 cm. Ten patients were diagnosed with tuberculosis (shown by the presence of caseating granulomas [n=10] and acid-fast bacilli [n=4]). Two patients had EUS-FNA results suggestive of histoplasmosis. The other patients had metastatic lung carcinoma (n=6), hepatocellular carcinoma (n=1), and adrenal lipoma (n=1) and adrenal myelolipoma (n=1). EUS results were not suggestive of any particular etiology. No procedure-related adverse events occurred. CONCLUSIONS: EUS-FNA is a safe and effective method for evaluating adrenal masses, and it yields diagnosis in cases where tissue diagnosis is impossible or has failed using conventional imaging modalities.
ABSTRACT
BACKGROUND: Endoscopic ultrasound (EUS)-guided drainage is an effective treatment for many abscesses in the abdomen. We review our experience with EUS-guided drainage of pelvic abscesses. METHODS: Thirty consecutive patients who underwent EUS-guided pelvic abscess drainage were evaluated after excluding three patients with distance to transducer >2 cm or organized abscess. RESULTS: Thirty patients (25 male) aged 60 ± 4.5 years (mean ± SD) had 4 prostatic abscesses, 7 perisigmoid abscesses, and 19 perirectal abscesses with mean ± SD sizes of 2.5 ± 0.3, 4.7 ± 0.6, and 5.4 ± 0.4 cm, respectively. Surgery was the most common predisposing factor (n = 14, 46.6 %) followed by diverticulitis (n = 5, 16.6 %). Interventions included aspiration only (2 prostatic and 3 perisigmoid), aspiration and dilatation (2 patients in each group), and dilatation and stenting (2 perisigmoid and 17 perirectal). Five (16.6 %) patients needed re-intervention, and two (6.6 %) needed surgery. There were no recurrences. Technical success of EUS-guided pelvic abscess drainage overall was 90.9 % (30/33) and was 93.3 % (27/30) in patients in whom EUS-guided drainage was attempted, with 16.5 % (n = 5) re-intervention rate. CONCLUSION: EUS-guided drainage has an excellent success rate in drainage of pelvic abscesses.
Subject(s)
Abscess/therapy , Drainage/methods , Endosonography , Pelvic Inflammatory Disease/therapy , Prostatic Diseases/therapy , Surgery, Computer-Assisted/methods , Aged , Female , Humans , Male , Middle Aged , Treatment OutcomeABSTRACT
The purpose of this investigation is to compare the rotational stability of intramedullary rod fixation with blade plate and screw fixation in tibiotalocalcaneal arthrodesis. Five matched pairs of cadaver ankles were randomly fixated with a lateral blade plate and screws or a retrograde intramedullary nail. The bone mineral density (BMD) for each sample was ascertained. These samples were tested through internal and external rotation of 0.5 degrees/s until 7 N-m was achieved. The torsional stiffness of each specimen was determined from the linear slope of the torque-rotation curve. No statistical difference in internal (p=.11) or external (p=.36) rotation for the matched pairs was noted. Data were excluded from one intramedullary sample secondary to early failure of the tibia. A trend toward increased rotational stability in the intramedullary group versus plate fixation in specimens with lower BMD was observed. These findings suggest no rotational biomechanical advantage of intramedullary nail compared to blade plate fixation in a cadaveric tibiotalocalcaneal arthrodesis model.
