Application of a single needle type for all image-guided biopsies: results of 100 consecutive core biopsies in various organs using a novel tri-axial, end-cut needle.

PURPOSE: To assess feasibility, results and complications in image-guided biopsies using a single needle design in various organs. MATERIALS AND METHODS: 100 consecutive percutaneous biopsies were performed in 54 females and 46 males aged 24-87 years (mean age/standard deviation: 64.5 +/- 12 years) using a full-core end-cut tri-axial full-automatic biopsy needle (18 gauge BioPince, InterV-MDTech, Gainesville, Florida) under CT (n = 45) or ultrasound (n = 55) guidance. In 63 biopsies a coaxial technique was used. RESULTS: Biopsies were obtained of liver (n = 32), lymph nodes (n = 17), thyroid (n = 11), lung (n = 9), adrenal (n = 9), pelvis (n = 6), chest wall/pleura (n = 6), mediastinum (n = 4), lytic bone lesions (n = 2), retroperitoneum (n = 1), muscle (n = 1), pancreas (n = 1), peritoneum (n = 1). Between 1 and 6 (mean/SD 2.83 +/- 0.92) needle passes were performed. In 77 cases a malignant (40 metastases, 37 primary tumours) and in 23 a benign lesion was diagnosed. Of the 23 benign lesions a specific diagnosis was possible in 22. In one case necrosis and haemorrhage was diagnosed. In this patient surgery and autopsy both revealed a mediastinal haematoma of unknown origin. Eight minor complications (mild pain/local haematoma requiring no therapy) and three major complications (three pneumothoraces in nine lung biopsies requiring two aspirations and one drainage) were observed. There was no mortality. CONCLUSION: Percutaneous image-guided biopsy using the described full-core end-cut needle resulted in a specific diagnosis in 99/100 consecutive biopsies in various organs with a low complication rate. We use this needle type for all CT- or US-guided biopsies in all organs except for solid bone.

Aluminum load in chronic intermittent plasma exchange.

Aluminum (Al) loading due to administration of human albumin (HA) solutions was studied in 2 patients with stable renal function who underwent plasma exchange once (patient A) and twice (patient B) per week for treatment of hyperviscosity syndrome. Al was determined by Zeeman-AAS in plasma before, during and after treatment, also in bone of one patient and in various preparations of HA from different manufacturers. In addition, the net Al uptake (difference between total Al influx and efflux) and the 24th urinary excretion between 2 exchanges were determined. The electrolyte solution used for dilution had no detectable Al, while HA contained between 15 and 1900 micrograms Al/l. Increase of Al in plasma after treatment was clearly related to Al content of the HA used. When the patients received substitution solutions based on inadvertently highly Al contaminated 20% HA (1419 micrograms/l), the average net uptake was 2265 in patient A and 2049 micrograms in patient B and plasma Al rose from 8.4 respectively 18.0 before to 69.2 and 86.5 micrograms/l after treatment. By using medium Al contaminated HA (574 micrograms/l), the net uptake was 742 (pat. A) and 819 micrograms (pat.B), and there was an elevation of plasma Al from 5.1 respectively 18.2 to 34.2 and 39.8 micrograms/l. Following a net uptake of 870 micrograms patient A excreted 668 micrograms Al until the next treatment (23% positive balance). Treating patient A with a low Al HA (47 micrograms/l), there was a slight increase of plasma Al from 10.8 to 16.2 micrograms/l, the net Al uptake was negligible (less than 10 micrograms), and the weekly Al balance was negative. After 10 months of plasma exchange therapy (patient A) there was no increase of Al in bone (6.4 micrograms/g). We conclude, that the use of HA with a low Al contamination is recommended for all patients receiving this therapy during chronic intermittent plasma exchange or for other indications, especially in cases with impaired renal function.