The percutaneous needle biopsy is safe and recommended in the diagnosis of musculoskeletal masses.

BACKGROUND: The purpose of this study was to analyze the role of percutaneous core needle biopsy in the diagnosis of musculoskeletal sarcomas. METHODS: One hundred eighty-five biopsy procedures were performed on 161 musculoskeletal tissue masses suspected of being a sarcoma in 155 patients who underwent subsequent tumor resection. A percutaneous core needle biopsy was performed on all masses either in the clinic or under radiologic guidance. If an adequate diagnosis could not be made on the basis of this biopsy specimen, an open incisional biopsy was performed. RESULTS: One hundred seventy-three core needle biopsy procedures were performed: 90 without radiologic guidance, 55 computed tomography guided, and 28 fluoroscopically guided. Twelve open incisional biopsies were performed. Eighty-three sarcomas, 67 benign mesenchymal tumors, and 11 metastatic epithelial tumors were identified. Analysis of the data reveals that only 7.4% of the masses required open biopsy. In 88.2% of the masses, a single percutaneous biopsy procedure was adequate, and no additional biopsy was necessary. There was a 1.1% rate of complications; none caused a change in the patient's treatment plan. There was a 1.1% rate of major diagnostic errors, none of which ultimately impacted on the patient's outcome. There were no unnecessary amputations. Percutaneous needle biopsy showed a positive predictive value of 100%, a negative predictive value of 82%, a sensitivity of 81.8%, and a specificity of 100%. The accuracy of a single-needle biopsy procedure to identify benign versus malignant lesions, exact grade, and exact pathology was 92.4%, 88.6%, and 72.7%, respectively. CONCLUSIONS: The percutaneous needle biopsy was found to be extremely effective and safe for the diagnosis of musculoskeletal masses. This method allowed 88% of patients with suspected sarcomas to undergo a single-needle biopsy procedure before the initiation of definitive treatment. Patients undergoing percutaneous needle biopsy had lower rates of major diagnostic errors and complications than previously described for open biopsy. Open biopsy offered limited additional information when preceded by a needle biopsy, given that these tumors were difficult to identify even after final resection.

Pine oil ingestion: a common cause of poisoning.

Pine oil is a common component of household cleaning solutions. We present the case of an elderly woman with dementia who ingested a household cleaning solution that contained pine oil and review the treatment of pine oil ingestion. The patient developed CNS depression and respiratory failure that required intubation and mechanical ventilation. A chest radiograph revealed diffuse alveolar interstitial infiltrates consistent with pneumonitis. The patient improved with supportive care. However, she developed nosocomial pneumonia, sepsis, and multiple organ failure and subsequently died. This case is illustrative of the increased risk for ingestion of toxic household compounds in the growing population of elderly and demented individuals, who are being cared for in the home. Pine oil ingestions are one of the most common accidental ingestions encountered in clinical practice. Clinical features of ingestion include depressed mentation, respiratory failure, and GI dysfunction. The treatment is supportive, and the ingestions are rarely fatal.

Red blood cell membrane dynamics in schizophrenia. II. Fatty acid composition.

Fatty acid compositions were determined in red blood cell (RBC) ghost membranes of schizophrenic patients before and after haloperidol withdrawal, as well as with age-matched normal male control subjects (n = 22). Patients on haloperidol (HD) received treatment in doses between 5 and 20 mg/day for at least 5 weeks (n = 24). Drug-free patients (n = 19) were free of all psychotropic medications for an average of 40 days. A highly significant decrease in the levels (nmol/ml packed RBC) of polyunsaturated fatty acids (PUFAs), particularly 18:2(n - 6) and 20:4(n - 6), was found in both HD-treated and drug-free patients. This decrease remained in those patients who had withdrawn from HD for more than 5 weeks (n = 10). Concomitantly, the percentage of saturated and monoenoic fatty acids to total fatty acids increased significantly in schizophrenic patients. The resultant fatty acid profile consequently lowers the unsaturation index (UI), which represents the average number of double bonds per fatty acid molecule, in RBC ghost membranes of schizophrenic patients. Furthermore, the decreases in UI were significantly correlated to the increases in "structure order" of RBC ghost membranes as measured by the steady-state fluorescence anisotropy (rs) in normal control and drug-free schizophrenic subjects. Therefore, it is likely that decreased levels of PUFAs in schizophrenic patients might result from a defective uptake of 18:2(n - 6) into RBC membrane phospholipids. Since fatty acid composition of membrane phospholipids affects the relative degree of membrane fluidity, the present results lend further support that RBC membrane dynamics are altered in schizophrenia.

Variable-interval schedules of timeout from avoidance: effects of anxiolytic and antipsychotic drugs in rats.

Concurrent performances were studied in rats under conditions where responses on one lever postponed shock on a Sidman avoidance schedule and responses on another lever produced periods of signaled timeout from avoidance on a variable-interval schedule. Chlorpromazine decreased rates of responding on both the timeout and avoidance levels to about the same extent. The effects of chlordiazepoxide and CGS 9896 depended upon the event maintaining responding. Both drugs increased responding on the timeout lever at doses that concurrently decreased responding on the avoidance lever. Thus, the novel anxiolytic CGS 9896 produced effects that closely resembled those of the benzodiazepine anxiolytic, chlordiazepoxide. Like chlorpromazine, buspirone decreased both avoidance and timeout responding. Despite the documented anxiolytic properties of buspirone, its actions here were unlike those of the other anxiolytic drugs tested. Nonetheless, the differentiation between drugs obtained with the timeout from avoidance procedure indicates its utility for behavioral pharmacology.