Fine needle aspiration biopsy of dense pulmonary lesions under computed tomography control.

UNLABELLED: The AIM of this article was to present our experience in the field of invasive diagnosis of dense pulmonary lesions (both benign and malignant). We consider the advantages and shortcomings of this method and the complication frequency (pneumothorax, haemothorax). MATERIALS AND METHODS: 92 patients (39 women and 53 men, aged between 24-70 years) underwent fine needle aspiration biopsy (FNAB) under computed tomography control (CTC). All biopsies were carried out by cutting needles 19-20G under computed tomography control with GE Sytec 3000 and Somaton Emotion Siemens. RESULTS: 86 biopsies were suitable for both cytological and histological diagnosis and 6 biopsies were suitable for cytological diagnosis alone. In 85 cases the material was obtained at the very first insertion of the biopsy needle while in the other 7 cases correction of the biopsy angle was performed after CT control. Twelve patients had partial pneumothorax as a complication and no haemothorax was registered. CONCLUSION: Under the control of modern CT equipment,when the biopsy needle is chosen correctly, the lesion is marked exactly and the manipulation is performed precisely, it is usually possible to obtain enough material for cytological and histological investigation with low risk of serious complications.

Ultrasonographic projection of a pathologic site on the anterior abdominal wall. Our own experience.

INTRODUCTION: The success of any operation depends to a great extent on how well the optimal surgical approach is chosen. The purpose of the present study was to propose a method of sonographic projection of an abdominal pathologic site on the anterior abdominal wall which can facilitate the selection of an optimal surgical approach. MATERIAL AND METHODS: The study included 26 patients aged 20 to 65 years operated on in the Clinic of Thoracic and Abdominal Surgery in the Medical University, Plovdiv between January 1996 and December 2001. Using ultrasonography we projected a pathologic site located in the abdomen on the anterior abdominal wall. A strip of adhesive band was placed on the scanning surface of a 3.5 MHz linear transducer to cast an acoustic shadow and thus draw the outlines of the site on to the anterior abdominal wall. RESULTS: Patients with liver hydatid cysts (primary and recurrent) and with recurrent calculous cholecystitis were predominant (20/26, 76.9%). The surgical approach in the cases of primary liver hydatid cysts was in the right hypochondriac region; after laparotomy it was extended in both directions. In the patients with recurrent liver hydatid cysts (6/26, 23.07%) the incision was made on the projected image, directly over the site; it was less traumatic and associated with less blood loss. In eight patients with chronic calculous cholecystitis (30.7%) the projection was used for minilaparotomy (up to 6 cm); in two patients the projection suggested that we should use the transrectal approach as optimal instead of the subcostal approach. The right subcostal approach was used in one patient with chronic calculous cholecystitis and retroperitoneal cyst instead of median laparotomy. In patients with retroperitoneal tumours and intra-abdominal non-organ echinococcosis the projection had confirmatory character. According to the review of the literature we made, such sonographic projection of pathologic sites on the anterior front wall for the purpose of selecting an optimal surgical approach has been done for the first time. CONCLUSIONS: 1. The sonographic projection of a pathologic site located in the abdomen on the anterior abdominal wall creates a direct visual association between intra-abdominal lesions and superficial structures (body constitution, subcutaneous fat, operative cicatrices). 2. This direct visual association, as well as the information provided about the depth, size and relation to adjacent organs helps the surgeon to choose the most appropriate surgical approach.

Thibierge--Weissenbach syndrome--a dynamic 17-year follow-up.

The case of a 55-year-old woman with Thieberge--Weissenbach syndrome is presented in this report. The disease was recognized as a separate diagnostic entity in 1985. This study is focused on the clinical features and the course of the syndrome. Over a period of 17 years multiple X-ray examinations of the affected organs were performed. The role of radiography for the dynamic follow-up of the disease course is discussed.