CT-Guided Percutaneous Lung Biopsies in Patients With Suspicion for Infection May Yield Clinically Useful Information.

OBJECTIVE: The objective of our study was to assess the frequency and time frame with which CT-guided lung biopsies for suspected infection yield information that can affect patient management. MATERIALS AND METHODS: All CT-guided lung biopsies over a 68-month period performed for the purpose of diagnosing a suspected infection were reviewed to determine the proportion that yielded information affecting patient management. Patients were included if infection was the only consideration causing the pulmonary lesion in question. RESULTS: Twenty-one biopsies were performed to identify a specific organism causing infection in patients with suspected infection; all patients were receiving antibiotics, 20 (95%) were immunocompromised, and 15 (71%) had undergone a prior bronchoscopy. Material collected from the biopsy provided a diagnosis in nine (43%) patients, whereas the biopsy results were nondiagnostic in the remaining 12 (57%). Of the nine patients for whom the biopsy yielded a diagnosis, eight biopsies revealed the species causing an infection (38%) and one biopsy (5%) detected posttransplant lymphoproliferative disease. Of the nine diagnoses, management was changed as a result of the biopsy in six patients (29% of all patients). The organisms identified by CT-guided lung biopsy in eight patients were fungi of the order Mucorales (i.e., mucormycosis) (n = 3), Aspergillus (n = 3), Pseudomonas (n = 1), and Nocardia (n = 1). The mean elapsed time between biopsy and pathologic diagnosis was 4 days (median, 3 days). There was no association between prior bronchoscopy and nondiagnostic biopsy results. CONCLUSION: CT-guided lung biopsies in patients with a high pretest suspicion for infection result in information sufficient to change patient management in 29% of patients. Organisms identified in these patients were most frequently fungi.

The influence of hip mobility and quadriceps fatigue on sagittal spinal posture and muscle activation in rugby scrum performance.

Rugby Union scrumming puts the spine under a high degree of loading. The aim of the current study was to determine how sagittal hip range of motion and quadriceps fatigue influence force output, spinal posture, and activation of the trunk and quadriceps muscles in rugby scrumming. Measures of sagittal hip flexion/extension range of motion were collected from 16 male varsity and club first XV level participants. Sagittal spine motion (electromagnetic motion capture), trunk and quadriceps activation (electromyography), and applied horizontal compressive force (force plate) were measured during individual machine scrumming. Participants performed a 5-trial scrum block involving 5 s of contact with 1-2 min recovery between each trial. They then performed a fatiguing protocol (wall sit to failure) and immediately returned to the scrum machine to perform another five trials. Though there was no significant influence of fatigue on the horizontal compressive force applied during contact (P = .83), there was a 52% increase in cervical flexion (P < .001), as well as decreased (18-23% lower) abdominal and erector spinae muscle activation (P < .05). Furthermore, quadriceps activation decreased (12-25% lower) over the course of the initial scrum block but increased (13-15% higher) in the post fatigue block (P < .05). Although athletes were able to maintain force output following the fatiguing wall sit task, there is the potential that they may be at an increased risk of spinal injury due to the combination of increased flexion and high-applied compressive force; a combination which has been shown to increase the likelihood of intervertebral disc herniation.

Nonclotted Blood Patch Technique Reduces Pneumothorax and Chest Tube Placement Rates After Percutaneous Lung Biopsies.

PURPOSE: The aim of this study was to determine whether autologous nonclotted blood patch decreases pneumothorax and chest tube placement rates in computed tomography-guided biopsies of the lung. MATERIALS AND METHODS: Percutaneous computed tomography-guided lung biopsies performed over a period of 6 years were retrospectively reviewed to determine the overall rates of pneumothorax and chest tube placement and rates before and after the autologous nonclotted blood patch procedure was instituted as a departmental policy. The effect of the intervention was only assessed in patients in whom a blood patch could be applied, therefore only when the needle traversed an aerated lung and only when the needle remained in the lung at the end of the study. RESULTS: There was a statistically significant decrease in both the rate of pneumothorax [28% (69/245) vs. 42% (80/189); P=0.002] and chest tube placement [4% (10/245) vs. 16% (30/189); P<0.001] in patients who received nonclotted blood patch versus those who did not. Blood patch was performed in 222/312 (71%) eligible patients after the introduction of the blood patch policy. After policy introduction, there was a decreased rate of pneumothorax, with a rate of 32% (101/312) versus 40% (49/122) (P=0.12) and a statistically significant decrease in departmental chest tube placement rates of 6% (20/312) versus 16% (20/122) (P=0.001). CONCLUSIONS: Nonclotted autologous blood patch for percutaneous lung biopsy resulted in significantly decreased pneumothorax and chest tube placement rates in our patient population.