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1.
Medicine (Baltimore) ; 100(3): e24001, 2021 Jan 22.
Artigo em Inglês | MEDLINE | ID: mdl-33545994

RESUMO

ABSTRACT: We aim to compare the diagnostic accuracy, safety, and radiation exposure between low-dose and standard-dose computed tomography (CT)-guided cutting needle biopsy (CNB) for lung nodules.From January 2016 to August 2017, all consecutive patients admitted with lung nodule underwent low-dose or standard-dose CT-guided CNB procedure in our center. Diagnostic accuracy and radiation dose were compared.A total of 67 and 69 patients who underwent low-dose and standard-dose CT-guided CNB procedure were included in this study. Each patient underwent CT-guided CNB for 1 nodule. The technical success rates were 100% in both groups. The sensitivity, specificity, and overall diagnostic accuracy were 97.7%, 100%, and 98.5% for low-dose group and 91.5%, 100%, and 94.2% for standard-dose group. There was no significant difference in diagnostic accuracy (P = .380) between 2 groups. Pneumothorax was found in 8 and 15 patients in the low-dose and standard-dose groups, respectively (11.9% vs 21.7%, P = .127). Hemoptysis was found in 10 and 10 patients in the low-dose and standard-dose groups, respectively (14.9% vs 14.5%, P = .943). The mean dose-length product was 38.2 ±â€Š17.2 mGy-cm and 375.3 ±â€Š115.7 mGy-cm in the low-dose and standard-dose groups (P < .001). The mean dose-length product was 38.2 ±â€Š17.2 mGy-cm and 375.3 ±â€Š115.7 mGy-cm in the low-dose and standard-dose groups, respectively (P < .001). The mean effective dose was 0.5 ±â€Š0.2 mSv and 5.3 ±â€Š1.6 mSv in the low-dose and standard-dose groups, respectively (P < .001).Low-dose CT-guided CNB of lung nodules significantly decreased radiation dose compared with standard-dose CT. The low-dose protocol could provide similar diagnostic accuracy and safety as standard-dose CT-guided CNB for lung nodules.


Assuntos
Biópsia por Agulha/métodos , Detecção Precoce de Câncer/métodos , Biópsia Guiada por Imagem/métodos , Neoplasias Pulmonares/diagnóstico , Doses de Radiação , Tomografia Computadorizada por Raios X , Idoso , Biópsia por Agulha/efeitos adversos , Feminino , Hemoptise/etiologia , Humanos , Biópsia Guiada por Imagem/efeitos adversos , Pulmão/patologia , Masculino , Pessoa de Meia-Idade , Pneumotórax/etiologia , Exposição à Radiação/efeitos adversos , Exposição à Radiação/análise , Lesões por Radiação/etiologia , Estudos Retrospectivos , Sensibilidade e Especificidade
2.
Isr Med Assoc J ; 22(12): 765-769, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33381949

RESUMO

BACKGROUND: Lung percutaneous needle biopsy (PNB) is routinely used to diagnose lung cancer. The most prevalent complications of PNB are pneumothorax and bleeding. Differences in characteristics of medical procedures between rural and urban hospitals are well known. OBJECTIVES: To compare characteristics of patients and lesions between two hospitals and to evaluate whether lung PNB complications differ in rural vs. urban settings. METHODS: The authors examined case records of 561 patients who underwent lung biopsy at two different medical centers in Israel: Tel Aviv Sourasky Medical Center (urban) and Barzilai Medical Center (rural). To evaluate the complication rates, the authors analyzed findings from chest X-ray performed 2 hours after biopsy and computed tomography (CT) images at the site of biopsy. RESULTS: The study comprised 180 patients who underwent lung biopsy at Barzilai and 454 at Sourasky. The rate of pneumothorax did not differ between centers (12% at Barzilai and 19% at Sourasky, P = 0.08). Distance from pleura was positively correlated to pneumothorax occurrence in both centers; however, neither lesion size nor lesion locus was found to be a risk factor for pneumothorax. Mild bleeding at the biopsy site occurred equally at Barzilai and Sourasky (32% vs. 36%, P = 0.3, respectively). Furthermore, immediate CT post-biopsy at Barzilai showed 95% negative predictive value, showing that a CT scan performed immediately after lung biopsy cannot replace the routine follow-up chest X-ray in predicting iatrogenic pneumothorax. CONCLUSIONS: CT-guided percutaneous lung biopsies are comparable between rural and urban hospitals regarding procedure characteristics and complication rates.


Assuntos
Biópsia por Agulha/métodos , Hospitais Rurais , Pulmão/patologia , Radiografia Intervencionista , Biópsia por Agulha/efeitos adversos , Hemorragia/etiologia , Hospitais Urbanos , Humanos , Israel , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/patologia , Pneumotórax/etiologia , Radiografia Intervencionista/métodos , Estudos Retrospectivos , Tomografia Computadorizada por Raios X
4.
Niger J Clin Pract ; 23(9): 1183-1187, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32913154

RESUMO

Aims: This study compared the analgesic effect of apical peri-prostatic block with that of intra-rectal xylocaine gel for trans-rectal ultrasound guided prostate biopsy (TRUS-PBx) in Nigeria. Methods: This is a prospective randomized comparative study carried out over one year in University of Benin Teaching Hospital, Edo State, Nigeria. The participants were randomized into two groups; Group A had 10 mls of intra-rectal xylocaine gel instillation while Group B had apical infiltration of 10 mls of 1% xylocaine all before TRUS-PBx. Result: There was a statistically significant difference in the mean pain score during and one hour after TRUS-PBx between Group A and Group B of the study population respectively (p < 0.0001). Those that had intra-rectal xylocaine gel (Group A) had more pain during and after biopsy. There was no difference in the mean pain score during probe insertion between the two groups (p = 0.952). Conclusion: This study demonstrated the superiority of apical peri-prostatic nerve block over intra rectal xylocaine gel instillation during TRUS-PBx with respect to its anesthetic efficacy. Therefore, centers providing TRUS-PBx in Nigeria should consider apical peri-prostatic nerve block as their mode of anesthesia for the procedure due to its efficacy and high safety profile.


Assuntos
Biópsia por Agulha/métodos , Biópsia Guiada por Imagem/métodos , Lidocaína/administração & dosagem , Bloqueio Nervoso/métodos , Dor/prevenção & controle , Próstata/patologia , Neoplasias da Próstata/diagnóstico , Neoplasias da Próstata/patologia , Administração Retal , Idoso , Anestésicos Locais/administração & dosagem , Biópsia por Agulha/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Nigéria , Dor/etiologia , Medição da Dor , Estudos Prospectivos , Próstata/diagnóstico por imagem , Próstata/inervação , Reto/patologia , Ultrassonografia de Intervenção
5.
PLoS One ; 15(7): e0235599, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32649662

RESUMO

BACKGROUND: As percutaneous transthoracic needle biopsy (PTNB) of the lung is a well-established diagnostic method for the evaluating pulmonary lesions, evidence of safety based on representative data is limited. This study investigated the practice patterns of PTNB of the lung and assessed the incidence and risk factors of PTNB-related severe pneumothorax in Korea. METHODS: We used a national-level health insurance database between January 1, 2007 and December 31, 2015. Patients who underwent PTNB of the lung were identified using procedure codes for organ biopsy, fluoroscopy, computed tomography, chest radiography, and lung-related diagnosis codes. The annual age-/sex-standardized rate of PTNB and the incidence of PTNB-related severe pneumothorax were calculated. We defined severe pneumothorax as the pneumothorax requiring intervention. The odds ratios of risk factors were assessed by a generalized estimating equation model with exchangeable working correlation matrix to address clustering effect within institution. RESULTS: A total of 66,754 patients were identified between 2007 and 2015. The annual age-/sex-standardized rate of PTNB per 100,000 population was 19.6 in 2007 and 22.4 in 2015, and it showed an increasing trend. The incidence of severe pneumothorax was 2.4% overall: 2.5% in men and 1.2% in women, and 2.6%, 2.7%, 2.1%, 2.1%, 1.9%, 2.4%, and 2.4% from 2009 to 2015. Older age (≥60), male sex, presence of chronic obstructive pulmonary disease, receiving treatment in an urban or rural area versus a metropolitan area, and receiving treatment at a general hospital were significantly associated with the risk of severe pneumothorax. CONCLUSIONS: Considering the increasing trend of PTNB, more attention needs to be paid to patients with risk factors for severe pneumothorax.


Assuntos
Biópsia por Agulha/efeitos adversos , Pulmão/patologia , Pneumotórax/etiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Bases de Dados Factuais , Feminino , Humanos , Seguro Saúde/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Risco , Fatores de Risco , Adulto Jovem
6.
Medicine (Baltimore) ; 99(27): e21076, 2020 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-32629740

RESUMO

BACKGROUND AND OBJECTIVE: Undiagnosed pleural effusions (UPEs) are a common problem of respiratory medicine, leading to an increased diagnostic burden globally. However, the most efficient and cost-effective approaches to UPEs remain controversial. This study aimed to assess the diagnostic value of ultrasound-guided needle biopsy (UGNB) in UPEs. METHODS: We conducted a search of PubMed, Embase, the Cochrane Library and reference lists of retrieved studies with no publication data limitation. Articles that investigated the diagnostic accuracy of UGNB in UPEs were included. The quality of eligible studies was assessed using Quality Assessment of Diagnostic Accuracy Studies-2. The diagnostic value of UGNB was evaluated by calculating the pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds rate, and the area under the curve for the summary receiver operating characteristic curve using a random effects model. RESULTS: Seven studies comprising 165 patients with UPEs met the inclusion criteria. UGNB had a pooled sensitivity of 83% (95% confidence intervals [CI], 75% - 89%), a specificity of 100% (95% CI, 90% - 100%), a positive likelihood ratio of 8.89 (95% CI, 3.29 - 24.02), a negative likelihood ratio of 0.23 (95% CI, 0.16 - 0.33), a diagnostic odds rate of 51.47 (95% CI, 14.70 - 180.16), and an area under the curve of 0.94. Six pneumothorax cases (3.6%), 5 local wound infections (3.0%), and 1 empyema case (less than 1%) were observed. There was no significant heterogeneity or publication bias in this study. CONCLUSIONS: Based on current evidence, UGNB is a safe and convenient procedure with a high accuracy for diagnosing UPEs. However, physicians should still be cautious in interpreting negative UGNB results.


Assuntos
Biópsia Guiada por Imagem/instrumentação , Derrame Pleural/patologia , Ultrassonografia de Intervenção/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia por Agulha/efeitos adversos , Biópsia por Agulha/métodos , Empiema/epidemiologia , Humanos , Biópsia Guiada por Imagem/efeitos adversos , Pessoa de Meia-Idade , Derrame Pleural/diagnóstico por imagem , Pneumotórax/epidemiologia , Sensibilidade e Especificidade , Ultrassonografia de Intervenção/efeitos adversos , Infecção dos Ferimentos/epidemiologia , Adulto Jovem
7.
Am J Emerg Med ; 38(9): 1984.e1-1984.e3, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32505475

RESUMO

INTRODUCTION: Systemic reactions from local tetracaine use are often an anomaly - not only is tetracaine short-acting and quickly metabolized by the pseudocholinesterase system leading to very limited systemic uptake, but most adverse reactions are usually associated with dental or spinal anesthesia. Furthermore, reactions to local anesthetics manifest in standard allergy-type reactions. When local anesthetics lead to nervous or cardiac system abnormalities, it is termed a local anesthetic systemic toxicity - an event with an incidence currently estimated to be 0.03%. CASE PRESENTATION: We present a case of a 56-year-old female who experienced a systemic reaction to tetracaine 1% while undergoing a fine needle biopsy of a thyroid nodule. The patient had previous allergic reactions to lidocaine. Upon conclusion of the procedure, the patient began convulsing and became rigid and non-verbal. She was able to move all extremities, had no respiratory distress, no swelling, hives, or redness, and was swallowing without difficulty. After about 5 min, the patient began to improve and experienced reversal of all previous symptoms. Her physical exam and labs were otherwise normal, she returned to her baseline functioning, and was discharged without any medical interventions. DISCUSSION: This case illustrates a case of LAST in a patient with previous Lidocaine allergy without any other obvious risk factors. There have been no cases of cross-reaction between lidocaine and tetracaine so it explores the possibility of patients having cross reaction to those two different kinds of local anesthetic.


Assuntos
Anestésicos Locais/toxicidade , Convulsões/induzido quimicamente , Tetracaína/toxicidade , Anestesia Local/efeitos adversos , Anestesia Local/métodos , Biópsia por Agulha/efeitos adversos , Feminino , Humanos , Pessoa de Meia-Idade , Nódulo da Glândula Tireoide/patologia
8.
PLoS One ; 15(4): e0231523, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32298324

RESUMO

BACKGROUND: Ultrasound-guided transthoracic core needle biopsy (US-TCNB) is a promising method for establishing the correct diagnosis of mediastinal masses. However, the existing studies in this area are scant and with small samples. PURPOSE: To evaluate the diagnostic value and the complication rate of US-TCNB, particularly large bore cutting biopsy in patients with mediastinal lesions. MATERIAL AND METHODS: This retrospective study includes 566 patients with mediastinal lesions suspicious of malignancy evaluated between March 2004 and December 2018. Inclusion criteria: 1. Patients with mediastinal lesions detected on thoracic CT scan; 2. Lesions more than 15 mm; 3. Negative histological diagnosis after bronchoscopic biopsy; 4. Normal coagulation status; 5. Cooperative patient; 6. Written informed consent. US visualization of the mediastinal lesions was successful in 308 (54.4%). In all of them, US-TCNB was performed. All patients with mediastinal lesions unsuitable for US visualization were evaluated for a CT-guided transthoracic needle biopsy (CT-TTNB), which was done if the presence of a safe trajectory was available (n = 41, 7.2%). All patients inappropriate for image-guided TTNB were referred to primary surgical diagnostic procedures (n = 217, 38.3%). RESULTS: The US-TCNB is a highly effective (accuracy 96%, sensitivity 95%) and safe tool (2.6% complications) in the diagnosis of all subgroups mediastinal lesions. It is non-inferior to CT-TTNB (90%) and comes close to the effectiveness of surgical biopsy techniques (98.4%), but is less invasive and with a lower complication rate. CONCLUSION: US-TCNB of mediastinal lesions is highly effective and safe tool which is particularly helpful in critically ill patients.


Assuntos
Biópsia por Agulha/métodos , Neoplasias do Mediastino/diagnóstico , Mediastino/patologia , Ultrassonografia de Intervenção/métodos , Biópsia por Agulha/efeitos adversos , Feminino , Humanos , Masculino , Neoplasias do Mediastino/diagnóstico por imagem , Neoplasias do Mediastino/patologia , Mediastino/diagnóstico por imagem , Pessoa de Meia-Idade , Estudos Retrospectivos , Ultrassonografia de Intervenção/efeitos adversos
9.
Med Sci Monit ; 26: e921350, 2020 Mar 22.
Artigo em Inglês | MEDLINE | ID: mdl-32200388

RESUMO

BACKGROUND To facilitate early treatment, we constructed a nomogram to predict risk of postoperative fever before prostate biopsy in patients with high risk of fever. MATERIAL AND METHODS We collected information on patients undergoing prostate biopsy from January 2015 to December 2018 from their medical records, including clinical characteristics and laboratory test results. Finally, after strict screening, the prediction model was established in 440 patients who underwent a transrectal prostate biopsy (TRPB). We divided these patients into a training group and validation group at a ratio of 7: 3, respectively. Univariate analysis and multivariate logistic regression analysis were used to select the predictors and to develop the model. Calibration curve and C-index were used to evaluate the accuracy of the nomogram, while DCA was used to assess the clinical value. RESULTS The individualized predictive nomogram contained 3 clinical features - Biopsy-positive rate (BPR), Hematuria, and Urine WBC - significantly associated with post-biopsy fever. The nomogram had good discriminating ability in both the training group and validation group - the C-index was 0.774 (95% CI=0.717-0.832) in the training group and 0.808 (95% CI=0.706-0.909) in the validation group. Hosmer-Lemeshow test proved a good calibration curve fit. The DCA curve suggested that the nomogram would have good clinical utility. CONCLUSIONS This is the first study to develop a nomogram to predict fever after prostate biopsy via Biopsy-positive rate (BPR), Hematuria, and Urine WBC. Use of this nomogram might help prevent fever and infection, and could facilitate individualized medical treatment after prostate biopsy.


Assuntos
Biópsia por Agulha/efeitos adversos , Febre/epidemiologia , Nomogramas , Neoplasias da Próstata/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Biópsia por Agulha/métodos , Hematúria , Humanos , Contagem de Leucócitos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/prevenção & controle , Valor Preditivo dos Testes , Próstata/patologia , Doenças Prostáticas/diagnóstico , Doenças Prostáticas/patologia , Neoplasias da Próstata/patologia , Estudos Retrospectivos , Ultrassonografia de Intervenção , Urina/citologia
10.
Medicine (Baltimore) ; 99(6): e19093, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32028433

RESUMO

Percutaneous biopsy in breast cancer has been associated with an increased risk of malignant cell seeding. However, the importance of these observations remains obscure due to lack of corroborating evidence from clinical studies. We determined whether method of biopsy is associated with breast cancer survival. This hospital registry-based cohort study included 3416 non-metastatic breast cancer patients diagnosed from 1993 to 2011 in a tertiary setting. Factors associated with biopsy methods were assessed. Multivariable Cox regression analysis was used to determine the independent prognostic impact of method of biopsy. Overall, 990 patients were diagnosed by core needle biopsy (CNB), 1364 by fine needle aspiration cytology (FNAC), and 1062 by excision biopsy. Excision biopsy was significantly associated with more favorable tumor characteristics. Radiotherapy modified the prognostic impact of biopsy method (Pinteraction < .001). Following multivariable analysis, excision biopsy was consistently associated with lower risk of mortality compared to FNAC in women receiving adjuvant radiotherapy (adjusted hazard ratio: 0.81, 95%CI: 0.66-0.99), but not in those who did not receive adjuvant radiotherapy (adjusted hazard ratio: 0.87, 95%CI: 0.65-1.17). While the risk of mortality was not different between patients undergoing FNAC and CNB when radiotherapy is administered, in the absence of radiotherapy, CNB was associated with higher risk of mortality than FNAC (adjusted hazard ratio: 1.57, 95%CI: 1.16-2.12). Given that our results contradict with findings of previous clinical studies assessing the prognostic impact of method of biopsy in women with breast cancer, further studies are warranted.


Assuntos
Biópsia/métodos , Neoplasias da Mama/diagnóstico , Adulto , Biópsia/efeitos adversos , Biópsia por Agulha Fina/efeitos adversos , Biópsia por Agulha Fina/métodos , Biópsia por Agulha/efeitos adversos , Biópsia por Agulha/métodos , Mama/patologia , Neoplasias da Mama/mortalidade , Neoplasias da Mama/patologia , Feminino , Humanos , Estimativa de Kaplan-Meier , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Sistema de Registros , Análise de Sobrevida
11.
Niger J Clin Pract ; 23(2): 246-251, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32031101

RESUMO

Aims: This study aims to discuss the relationship between complications and patient characteristics and lesion properties in the transthoracic fine needle aspiration biopsy (TTFNAB) procedures performed for lung lesions and the treatment applied in our clinic to eliminate these complications. Methods: In this retrospective study conducted from July 2014 to August 2017, the CT-guided TTFNAB was performed on 186 patients (145 males, 41 females) who were considered to have malignancies on their clinical evaluation, CT, and PET CT results. Results: After 186 CT-guided TTFNAB interventions, a total of 24 (12.9%) patients developed procedure-related pneumothorax. Of these patients, 7 had a limited and minimal pneumothorax and no treatment was required for them, while 17 had a large and increasing pneumothorax and manual air aspiration was performed with coaxial needle during the procedure. The number pleural transitions (OR 6.513; 95%, 2,529-16,771 P < 0.001), emphysematous lungs (OR 4.612; 95%, 1,852-11.487 P < 0.001), and the presence of a lesion unrelated to the pleura (OR 8.205; 95%, 3,162-21,291 P < 0.001) can form the basis for the development of a pneumothorax. Conclusion: The chances of developing pneumothorax after TTFNAB depend on number of pleural transition, emphysematous lungs, and non-pleural lesions. However, it is considered that procedures such as manual air aspiration and autologous blood patch may reduce the need for chest tube following the development of pneumothorax.


Assuntos
Biópsia por Agulha Fina/efeitos adversos , Biópsia por Agulha/efeitos adversos , Biópsia por Agulha/instrumentação , Pulmão/patologia , Pneumotórax/etiologia , Radiografia Intervencionista , Adulto , Idoso , Tubos Torácicos/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pneumotórax/terapia , Enfisema Pulmonar , Testes de Função Respiratória , Estudos Retrospectivos , Fatores de Risco , Tomografia Computadorizada por Raios X/efeitos adversos
12.
Arthritis Care Res (Hoboken) ; 72(10): 1497-1505, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-31421034

RESUMO

OBJECTIVE: To study the efficacy, tolerability, safety, and sampling variation of ultrasound (US)-guided synovial biopsies performed in clinical practice and research. METHODS: We included all patients who had a US-guided synovial needle biopsy from November 2013 to January 2018. Patients were evaluated for procedure safety and tolerability. Usefulness of synovial biopsy was considered based on contribution for achieving the proposed aims. We analyzed samples for presence and quality of synovial tissue, synovitis score/grade, and pathotype. Variation across patients, samples, section levels, and sampling order was assessed. RESULTS: A total of 64 US-guided synovial biopsies were performed (n = 52 in clinical practice, n = 12 in research). Patient tolerability (70% no/mild discomfort) was remarkably high. There was no significant aggravation of symptoms or US synovitis in the biopsied joint. Procedures were overall safe, with few minor, 2 moderate, and no major adverse events. Usefulness of US-guided synovial biopsies was high, both in clinical practice (37% direct diagnostic impact, 100% positive/95% negative predictive values for infection) and in research (92% success). Synovial tissue was retrieved in 88% of biopsies, with a median of 75% gradable samples. There was significant variation in sample quality and synovitis features across patients and samples, but not between different section levels. Samples collected later in the procedure had a lower frequency of synovial tissue and were poorly concordant in pathotype with those collected earlier. CONCLUSION: US-guided synovial needle biopsy is an effective, safe, and well-tolerated means to collect good quality synovial tissue for clinical and research purposes. Samples collected for different aims should be retrieved in parallel, rather than sequentially.


Assuntos
Biópsia por Agulha/estatística & dados numéricos , Membrana Sinovial/patologia , Ultrassonografia de Intervenção/estatística & dados numéricos , Adulto , Idoso , Biópsia por Agulha/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Ultrassonografia de Intervenção/efeitos adversos
13.
Clin Radiol ; 75(2): 158.e9-158.e14, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31718788

RESUMO

AIM: To determine the clinical significance of variation in haematocrit (Ht) and haemoglobin (Hb) values before and after image-guided percutaneous core needle biopsies (PCNBs) and evaluate its clinical significance. MATERIALS AND METHODS: This single-centre, retrospective study included all the patients who underwent image-guided PCNBs between November 2012 and September 2018. In total, 105 cases (56 male; 53.3%; mean age 72±8 years) were available for analysis. Biopsies included lesions of the liver, lung, kidney, bone, paravertebral and soft-tissue masses, peritoneal implantations, and retroperitoneal neoplasms. The study's primary outcome was to compare the pre- and post-procedural Ht and Hb values and to evaluate their clinical significance. RESULTS: A significant decrease of the mean Hb and Ht values was detected post-biopsy (12.79±1.85 g/dl versus 12.03±1.72 g/dl and 38.75±4.93% versus 36.49±4.73%; p<0.0001). A decrease in the Ht and/or Hb level was noted in 93/105 (88.6%) and 94/105 (89.5%) of the patients; respectively. Four minor bleeding complications were noted (4/105; 3.8%), which resolved without any further treatment. An >4% decrease in Ht value was noted in 17/105 cases (16.2%) and an Hb decrease of ≥1.5 mg/dl was noted in 10/105 cases (9.5%), all without any haemodynamic compromise. CONCLUSIONS: A moderate post-PCNB decrease in Ht and Hb values compared to baseline should be expected, but should not raise concerns regarding an ongoing bleeding event, if not correlated with haemodynamic and clinical signs of haemorrhage.


Assuntos
Biópsia por Agulha , Hematócrito , Hemoglobinas/análise , Biópsia Guiada por Imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia por Agulha/efeitos adversos , Feminino , Humanos , Biópsia Guiada por Imagem/efeitos adversos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
14.
Int Braz J Urol ; 46(1): 60-66, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31851459

RESUMO

OBJECTIVES: To investigate the characteristics of cases of NIH category I acute prostatitis developed after transrectal prostate biopsy and clarifiy the risk factors and preventive factors. MATERIALS AND METHODS: We retrospectively reviewed the medical records of 3.479 cases of transrectal ultrasound-guided needle biopsies performed with different prophylactic antibiotherapy regimens at two different institutions between January 2011 and February 2016. The patients of Group I have received ciprofloxacin (n=1.523, 500mg twice daily) and the patients of Group II have received ciprofloxacin plus ornidazole (n=1.956, 500mg twice daily) and cleansing enema combination as prophylactic antibiotherapy. The incidence, clinical features and other related microbiological and clinical data, were evaluated. RESULTS: Mean age was 62.38 ± 7.30 (47-75), and the mean prostate volume was 43.17 ± 15.20 (21-100) mL. Of the 3.479 patients, 39 (1.1%) developed acute prostatitis after the prostate biopsy procedure. Of the 39 cases of acute prostatitis, 28/3.042 occurred after the fi rst biopsy and 11/437 occurred after repeat biopsy (p=0.038). In Group I, 22 of 1.523 (1.4%) patients developed acute prostatitis. In Group II, 17 of 1.959 (0.8%) patients developed acute prostatitis. There was no statistical difference between the two groups according to acute prostatitis rates (X2=2.56, P=0.11). Further, hypertension or DM were not related to the development of acute prostatitis (P=0.76, X2=0.096 and P=0.83, X2=0.046, respectively). CONCLUSIONS: Repeat biopsy seems to increase the risk of acute prostatitis, while the use of antibiotics effective for anaerobic pathogens seems not to be essential yet.


Assuntos
Antibacterianos/administração & dosagem , Antibioticoprofilaxia/métodos , Biópsia por Agulha/efeitos adversos , Ciprofloxacino/administração & dosagem , Enema/métodos , Ornidazol/administração & dosagem , Prostatite/etiologia , Idoso , Biópsia por Agulha/métodos , Combinação de Medicamentos , Humanos , Masculino , Pessoa de Meia-Idade , Próstata/patologia , Prostatite/prevenção & controle , Reprodutibilidade dos Testes , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Ultrassonografia de Intervenção
15.
Turk J Med Sci ; 49(6): 1701-1706, 2019 12 16.
Artigo em Inglês | MEDLINE | ID: mdl-31655516

RESUMO

Background/aim: We evaluate whether transrectal ultrasonography (TRUS)-guided prostate biopsy might lead to spillage of tumor cells into peripheral blood as a result of disruption of the epithelial barrier and ultimately result in metastasis. Materials and methods: Eighty-eight patients underwent TRUS-guided prostate needle biopsy due to prostate-specific antigen (PSA) increase or abnormal digital rectal examination at the Samsun Research and Training Hospital (Samsun, Turkey) between April 2016 and September 2018. Approximately 10 mL of whole blood was collected from patients before, 1 week after, and 1 month after biopsy. Samples were analyzed for CD117 positivity and prostate-specific membrane antigen (PSMA) levels using flow cytometry. Patients with pathologically determined prostate cancer and without CD117 positivity before biopsy were included in the study. The study group thus consisted of 55 patients. Results: Subjects' PSA levels ranged from 2.3 to 40.0 ng/mL (median: 7.9 ng/mL), and their Gleason score was a median of 7 (range: 5­9). PSMA levels ranged between 9.3 ng/mL and 118.5 ng/mL and CD117 antigen levels between 0 and 5. We detected no CD117- positive cells in blood samples collected 7 days or 1 month after biopsy. Conclusion: We detected no circulating tumor cells in the peripheral circulation following biopsy. Prostate needle biopsy seems to be a safe method in terms of spillage of tumor cells into blood circulation as a possible cause of further metastasis.


Assuntos
Biópsia por Agulha/métodos , Próstata/patologia , Neoplasias da Próstata/patologia , Ultrassonografia de Intervenção , Idoso , Antígenos de Superfície/sangue , Biópsia por Agulha/efeitos adversos , Citometria de Fluxo , Glutamato Carboxipeptidase II/sangue , Humanos , Masculino , Pessoa de Meia-Idade , Gradação de Tumores , Proteínas Proto-Oncogênicas c-kit/sangue , Ultrassonografia de Intervenção/efeitos adversos , Ultrassonografia de Intervenção/métodos
16.
BMJ Case Rep ; 12(10)2019 Oct 05.
Artigo em Inglês | MEDLINE | ID: mdl-31586955

RESUMO

Flexible bronchoscopy is a commonly performed procedure in pulmonary medicine. The common complications following bronchoscopy include minor bleeding, transient hypoxaemia, pneumothorax and others. Pneumothorax during diagnostic flexible bronchoscopy is mainly encountered after performing transbronchial lung biopsy. Iatrogenic pneumothorax is uncommon when lung biopsy is not performed. Herein, we report the unusual occurrence of pneumothorax following bronchoscopic suctioning while removing a mucus plug.


Assuntos
Aspergillus fumigatus/isolamento & purificação , Biópsia por Agulha/efeitos adversos , Broncoscopia/efeitos adversos , Pneumotórax/etiologia , Aspergilose Pulmonar/diagnóstico , Adulto , Diagnóstico Diferencial , Feminino , Humanos , Doença Iatrogênica , Muco , Aspergilose Pulmonar/patologia , Sucção/efeitos adversos
17.
Diagn Interv Radiol ; 25(6): 435-441, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31650972

RESUMO

PURPOSE: We aimed to evaluate the feasibility, accuracy, and complications of computed tomography (CT)-guided percutaneous transthoracic needle biopsy (PTNB) of cavitary lesions. METHODS: Consecutive PTNB procedures in an academic institution over a 4-year period were reviewed, 53 of which were performed on patients with cavitary lesions. The demographic data of patients, lesion characteristics, biopsy technique and complications, initial pathologic results, and final diagnosis were reviewed. A final diagnosis was established through surgical correlation, microbiology or clinico-radiologic follow-up for at least 18 months after biopsy. RESULTS: The overall accuracy of PTNB was 81%. In 33 patients (62%) the cavitary lesion was found to be malignant (23 lung cancers and 10 metastases). The sensitivity and specificity for malignancy was 91% and 100%, respectively. In 20 patients (38%) a benign etiology was established (16 infections and 4 noninfectious etiologies), with PTNB demonstrating a sensitivity of 81% and specificity of 100% for infection. Wall thickness at the biopsy site, lesion in lower lobe, and malignancy were significant independent risk factors for diagnostic success. Minor complications occurred in 28% of cases: 13 pneumothoraces (5 requiring chest tube), 1 small hemothorax, and 1 mild hemoptysis. A nonsignificant higher chest tube insertion rate was seen in cavities with a thinner wall. CONCLUSION: PTNB of cavitary lesions provides high accuracy, sensitivity, and specificity for both malignancy and infection and has an acceptable complication rate. Wall thickness at the biopsy site, lesion in lower lobe, and malignancy were significant independent risk factors for diagnostic success. Samples for microbiology should be obtained in all patients, especially in the absence of on-site cytology, due to the high prevalence of infection in cavitary lesions.


Assuntos
Biópsia por Agulha/efeitos adversos , Biópsia Guiada por Imagem/efeitos adversos , Pulmão/microbiologia , Pulmão/patologia , Idoso , Tubos Torácicos , Estudos de Viabilidade , Feminino , Hemoptise/etiologia , Hemotórax/etiologia , Humanos , Biópsia Guiada por Imagem/instrumentação , Neoplasias Pulmonares/epidemiologia , Neoplasias Pulmonares/microbiologia , Neoplasias Pulmonares/patologia , Masculino , Pessoa de Meia-Idade , Nódulos Pulmonares Múltiplos/epidemiologia , Nódulos Pulmonares Múltiplos/microbiologia , Nódulos Pulmonares Múltiplos/patologia , Metástase Neoplásica/patologia , Pneumotórax/etiologia , Pneumotórax/terapia , Prevalência , Estudos Retrospectivos , Fatores de Risco , Sensibilidade e Especificidade , Parede Torácica/patologia , Tomografia Computadorizada por Raios X/métodos
18.
Jpn J Radiol ; 37(12): 808-816, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31541398

RESUMO

PURPOSE: This study evaluated whether or not patterns of emphysema and their qualitative and quantitative severity can predict the risk of complications with post-computed tomography (CT)-guided transthoracic lung biopsy (TTLB). MATERIALS AND METHODS: Three hundred and ninety-seven patients who underwent CT-guided TTLB in 2010-2018 were retrospectively reviewed. The severity of emphysema and presence of perilesional emphysema were assessed visually using the Fleischner Society classification. Ninety seven of the 397 patients underwent quantitative analysis of emphysema. Complications, including pneumothorax, chest tube insertion, and hemorrhage, were assessed by post-TTLB CT and radiographic imaging. The grade of hemorrhage was categorized into three groups. Independent risk factors for pneumothorax and hemorrhage were assessed by univariate and multivariate logistic regression analyses. RESULTS: Pneumothorax occurred in 48.6% of cases and hemorrhage in 70.5%. Perilesional emphysema was significantly associated with pneumothorax (odds ratio 6.720; 95% confidence interval 3.265-13.831, p < 0.001) and hemorrhage (odds ratio 3.877; 95% confidence interval 1.796-8.367; p = 0.001). The severity of visual and quantitative emphysema was not a significant risk factor for pneumothorax or hemorrhage (p > 0.05). Perilesional emphysema was significantly associated with the grade of hemorrhage (p < 0.001). CONCLUSION: Perilesional emphysema can estimate the risk of iatrogenic complications from CT-guided TTLB.


Assuntos
Enfisema/complicações , Hemorragia/etiologia , Pulmão/patologia , Pneumotórax/etiologia , Radiografia Intervencionista/métodos , Tomografia Computadorizada por Raios X/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia por Agulha/efeitos adversos , Feminino , Humanos , Biópsia Guiada por Imagem/efeitos adversos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Adulto Jovem
19.
Medicine (Baltimore) ; 98(31): e16461, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31374007

RESUMO

Ultrasonography (USG)-guided fine needle aspiration (FNA) is widely used for diagnosis of lymph node (LN) metastasis in papillary thyroid cancer (PTC). However, FNA cytology sometimes shows inconclusive results. Recently, the measurement of thyroglobulin (Tg) in FNA washout fluid (aspirate-Tg) has been widely adopted, but there are some difficulties in the preparation of the sample and standardization of the procedure. Here, we examined serum Tg after FNA as a new predictive marker for LN metastasis of PTC. We performed USG-guided FNA cytology and examined aspirate-Tg in PTC patients showing suspicious metastatic LNs during follow-up. We measured baseline serum thyroid stimulating hormone (TSH), Tg, and Tg antibody levels before FNA, and serum Tg level within an hour after FNA. We defined aspirate-Tg level above 0.9 ng/mL as positive, and a 30% increase in serum Tg level after FNA compared to the baseline as elevation of serum Tg. Twenty-two patients were included in our study. Nine patients (40.9%) showed elevation of Tg level after FNA, and the mean value of Tg elevation was 24.8 ±â€Š48.0 ng/mL. Among these 9 patients, 8 were diagnosed with PTC and 1 patient showed cellular atypia on cytopathology. All these patients showed positive aspirate-Tg. Thirteen patients (59.1%) did not show elevation of Tg level after FNA. Among these patients, 2 had PTC, 2 had cellular atypia, and 9 yielded negative results for malignancy on cytopathology. Elevation of serum Tg level after FNA might have a diagnostic role for predicting LN metastasis of PTC.


Assuntos
Biópsia por Agulha/efeitos adversos , Tireoglobulina/análise , Câncer Papilífero da Tireoide/cirurgia , Adulto , Idoso , Biópsia por Agulha/métodos , Feminino , Humanos , Linfonodos/lesões , Linfonodos/metabolismo , Metástase Linfática/patologia , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Valor Preditivo dos Testes , Estudos Retrospectivos , Tireoglobulina/sangue , Câncer Papilífero da Tireoide/complicações , Ultrassonografia/métodos
20.
Eur J Radiol ; 117: 26-32, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31307649

RESUMO

OBJECTIVES: To evaluate the incidence and risk factors of systemic air embolism (SAE) depicted on systematic whole thoracic CT performed after percutaneous lung biopsy. METHODS: A total of 559 CT-guided lung biopsies performed between April 2014 and May 2016 were retrospectively evaluated. SAE was defined by the presence of air in the aorta or left cardiac cavities seen on whole thorax CT images acquired after needle withdrawal. Analyzed data focused on patient (age, sex, spirometry data, emphysema on CT, therapeutics received), target lesion (location, depth, size and feature) and procedure (patient position, length of intrapulmonary needle path, number of pleural passes and of biopsy samples, operator's experience). A regression logistic model was used to identify risk factors of SAE. RESULTS: SAE was observed after 27 of the 559 lung biopsies, corresponding to a radiological incidence of 4.8% (95%CI: 3.3-7.0). Clinical incidence was 0.17% (n = 1). For 21/27 patients (78%), a targeted acquisition in the nodule area would not have included the cardiac cavities meaning SAE would have been missed. On multivariate analysis, the independent risk factors were needle path length through ventilated lung (OR: 1.13, 95%CI: 1.02-1.25, p = 0.024), number of samples (OR: 1.48, 95%CI: 1.01-2.17, p = 0.046) and prone position (OR: 3.12, 95%CI: 1.11-8.31, p = 0.031) or right-sided lateral decubitus (OR: 6.15, 95%CI: 1.66-22.85, p = 0.005). CONCLUSIONS: Asymptomatic systemic air embolism can be depicted in almost 5% of post biopsy CT examinations, when they are not limited to the targeted nodule area but include the entire thorax.


Assuntos
Biópsia por Agulha/efeitos adversos , Embolia Aérea/etiologia , Radiografia Torácica , Tomografia Computadorizada por Raios X , Idoso , Biópsia por Agulha/métodos , Embolia Aérea/terapia , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco
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