ASPIRATION OF BREAST CYSTS

In 1,364 cases of breast cyst aspiration reported in the literature, there is no note of a missed diagnosis of carcinoma.The author carried out needle aspiration in 80 patients with a definite mass in the breast as a therapeutic or diagnostic procedure.A diagnosis must be established for every definite mass in the breast and needle aspiration is a logical diagnostic procedure. If the needle encounters a solid mass, the mass must be removed for biopsy. If the needle encounters a cyst containing fluid, the fluid should be removed completely. A biopsy specimen then should be taken from the mass if (a) the fluid is bloody, (b) the mass does not entirely disappear, or (c) the mass recurs promptly. Adherence to these rules will keep the examining physician from missing a carcinoma within the cyst.Aspiration of breast cysts is a simple and safe diagnostic and therapeutic procedure that saves the patient distress and money.     

Scalene node biopsy; an analysis of 42 cases

Scalene node biopsy was done in 42 patients with previously undiagnosed intrathoracic lesions. A definite histologic diagnosis was obtained in 25 patients. Scalene node biopsy is not only a valuable diagnostic procedure for intrathoracic lesions, but many times it may obviate the necessity of exploratory thoracotomy. If a diagnosis of carcinoma of lung is established by scalene node biopsy, the operability of the patient and the type of pulmonary resection should be carefully evaluated.     

SCALENE NODE BIOPSY—An Analysis of 42 Cases

Scalene node biopsy was done in 42 patients with previously undiagnosed intrathoracic lesions. A definite histologic diagnosis was obtained in 25 patients.Scalene node biopsy is not only a valuable diagnostic procedure for intrathoracic lesions, but many times it may obviate the necessity of exploratory thoracotomy. If a diagnosis of carcinoma of lung is established by scalene node biopsy, the operability of the patient and the type of pulmonary resection should be carefully evaluated.     

双气囊小肠镜在小肠出血中的应用价值

目的:观察双气囊小肠镜在小肠出血中的病变检出率、病因诊断率、耐受性和安全性,并探讨双气囊小肠镜对小肠出血的内镜下治疗情况.方法:对2006年3月至2009年11月烟台毓璜顶医院消化内科收治的可疑小肠出血患者102例行双气囊小肠镜检查,首选进镜方式分为经口或经肛2种,首选方式检查后未发现病灶者,日后改换进镜方式再行检查.对活动性出血病灶行内镜下止血治疗,小肠息内行息肉切除.结果:双气囊小肠镜的病变检出率为94.12%(96/102),病因诊断率为84.31%(86/102).其中35例检查时见病变活动性出血,行内镜下止血治疗,33倒止血成功,内镜止血成功率为94.30%(33/35);在耐受性方面.双气囊小肠镜的耐受性依次为:全麻下经肛进镜、全麻下经口进镜、非麻醉经肛进镜、非麻醉经口进镜.所有患者均未发生严重并发症.结论:双气囊小肠镜对小肠出血具有较高的病变检出率和病因诊断率,并且可行内镜下止血治疗,是一项安全、有效的临床诊疗方法.     

Colonoscopy in surgical practice.

Colonoscopy is a rewarding new technique with a potential for early and more accurate diagnosis. One hundred and seventy colonoscopies carried out over the past three years showed or confirmed colonic cancer in 14 patients, and solitary or multiple colonic polyps were found in 28 cases, of which 18 were excised endoscopically. A large villous adenoma was diagnosed in one patient, and the absence of a suspected sinister lesion was shown by direct examination and biopsy in 110 cases. There were 17 examination failures, including two perforations of the bowel. Colonoscopy complements rather than supplants barium enema examination and will make diagnostic laparotomy for colonic lesions unnecessary. The use of the diathermy snare allows endoscopic removal of colonic polyps and should greatly reduce the need for formal surgery in these cases. The financial saving to the Health Service will greatly outweigh the expense of the procedure, but it should be undertaken only in well organised centres as a specialist service for selected patients. In skilled hands it is safe, but potential hazards exist for the inexperienced endoscopist.     

Reliability and limitations of fine needle aspiration cytology of lymphadenopathies. An analysis of 1,261 cases

In a study spanning over two years, 1,261 cases with clinically significant lymphadenopathies were subjected to fine needle aspiration cytology (FNAC) to evaluate the reliability and limitations of the procedure. In the first phase of the study, consisting of 100 cases, the cytologic diagnosis was compared with histopathology, and the results were analyzed with a view to standardizing the procedure. In the second phase of the study, consisting of 1,161 patients, FNAC was used as the primary modality of diagnosis. Excision biopsy was done only when there was a clinical-cytologic discrepancy, failure to respond to treatment or FNAC diagnosis of non-Hodgkin's lymphoma. The highest diagnostic accuracy with FNAC was observed in metastatic carcinoma. Though tuberculous lymphadenitis, reactive hyperplasia and lymphoma were diagnosed with almost similar accuracy, reactive hyperplasia and non-Hodgkin's lymphoma proved difficult to diagnose. Although FNAC has proven to be a simple, safe, reliable and cost-effective diagnostic tool for lymphadenopathies, the limitations of the procedure should be kept in mind and excision biopsy used whenever required.     

INDICATIONS FOR ANGIOCARDIOGRAPHY

Angiocardiography is indicated in selected cases of heart disease in which a definite diagnosis cannot be made by ordinary methods or in which there is reasonable expectation that the information so obtained may influence the treatment of the patient. Whenever possible, angiocardiography should be done in conjunction with cardiac catheterization. The main indication for angiocardiography is cyanotic congenital heart disease; primarily those cases in which there is a right-to-left shunt. Angiocardiography is occasionally of value in diagnosis of other types of congenital heart disease and in acquired heart disease.     

La cyto-aspiration prostatique transrectale

The diagnosis of prostate adenocarcinoma by fine-needle aspiration cytology (FNAC) has taken long to accept as a simple, safe and reproducible procedure. The transrectal approach, as described for many years, remains the simplest method. Cytological samples need to be fixed with adequate solutions. Local anesthesia is not useful, and ultrasonographic guidance is not necessary. Reported sensitivity and specificity values of FNAC are 70–95% and 65–95% respectively, when biopsy is taken as the diagnostic reference. The correlation of cytological and Gleason’s grading is about 75%. Complications after transrectal sampling are very low, provided previous antibiotherapy is administrated. The indications for performing FNAC are limited, a histopathological diagnosis being necessary. Ultrasonographicallyguided biopsies should be done in every diagnostic and staging attempt. FNAC should be done more systematically in order to provide early diagnosis in patients presenting with non specific urologic symptoms.     

Myelography; diagnostic value in lesions of the lumbar intervertebral discs with variation in technique

Myelography using pantopaque in greater than usual amount with a variation in technique, which is described, is believed to provide increased accuracy in differential diagnosis and precise localization of lesions in the lumbar spine. The need for multiple space exploration is eliminated and more detailed information concerning the size and shape of lesions is provided as compared to that secured by the use of 3 or 6 cc. of opaque medium and fluoroscopic examination alone. In 53 cases in which lumbar myelography was performed and the diagnosis verified or disproved at operation, there was a 5 per cent diagnostic error in 41 instances in which the method outlined was used, as compared with 17 per cent error in 12 cases in which only 3 or 6 cc. of radiopaque material and fluoroscopy alone were used. The accuracy of the procedure would appear to warrant its use in the evaluation of patients suspected of having abnormalities of the lumbar discs associated with nerve root compression.     

The value of immunohistochemistry in increasing diagnostic precision of undifferentiated tumours by the surgical pathologist

Summary The availability of polyclonal and monoclonal antibodies allows immunohistochemical staining (immunofluorescence and immunoperoxidase) procedures to be used by the surgical pathologist, so as to obtain a definite diagnosis in cases where light microscopic examination of tissue sections from biopsy and surgical specimens is inconclusive. Four cases of undifferentiated tumors are described in which only a differential diagnosis could be obtained using light microscopy but a definite diagnosis was achieved when additional information was provided by immunohistochemistry. A scheme is presented for the use of immunohistochemistry to increase diagnostic precision in assessing tumours.     

MYELOGRAPHY—Diagnostic Value in Lesions of the Lumbar Intervertebral Discs with a Variation in Technique

Myelography using pantopaque in greater than usual amount with a variation in technique, which is described, is believed to provide increased accuracy in differential diagnosis and precise localization of lesions in the lumbar spine. The need for multiple space exploration is eliminated and more detailed information concerning the size and shape of lesions is provided as compared to that secured by the use of 3 or 6 cc. of opaque medium and fluoroscopic examination alone. In 53 cases in which lumbar myelography was performed and the diagnosis verified or disproved at operation, there was a 5 per cent diagnostic error in 41 instances in which the method outlined was used, as compared with 17 per cent error in 12 cases in which only 3 or 6 cc. of radiopaque material and fluoroscopy alone were used. The accuracy of the procedure would appear to warrant its use in the evaluation of patients suspected of having abnormalities of the lumbar discs associated with nerve root compression.     

Fiberoptic Bronchoscopy in Diagnosis of Opportunistic Lung Infections: Assessment of Sputa,Washings, Brushings and Biopsy Specimens

Fiberoptic bronchoscopy (washings, brushings and biopsies) was done in 25 cases of proven opportunistic pulmonary infections in compromised hosts. Diagnostic yields of bronchoscopic procedures and expectorated sputum were compared. Sputum examination gave the lowest yield (14 percent). Bronchial washings and brushings were diagnostic in 30 percent and 38 percent of patients, respectively. On transbronchial biopsy of the lung (TBB) pathogens were identified in 75 percent of patients with Pneumocystis carinii infection and 67 percent of patients with other opportunistic infections. The overall TBB yield of 73 percent was superior (P<0.05) to that of either washings or brushings. The yield from combining washings and brushings was greater than from either procedure alone, but combination with TBB did not result in any significant improvement. TBB is recommended as a useful diagnostic procedure in patients with suspected opportunistic pulmonary infections. Morbidity was minimal with this procedure, and the need for thoracotomy was reduced when it was used.     

Brush cytology of gastric malignancies

OBJECTIVE: To compare endoscopic biopsy and cytology versus biopsy alone in the diagnosis of gastric malignancies. STUDY DESIGN: This prospective study included 229 cases referred for endoscopy for visible gastric lesions during a four-year period (1996-2000). Both biopsy and brush cytology were performed, and all the slides were screened by a cytotechnologist and reviewed by a pathologist. RESULTS: Of the 229 cases, 97 (42.4%) were proven to be malignant and 132 (57.6%) definitely benign. Biopsy was positive in 90 patients (92.7%), while brush cytology was positive in 85 (87.1%). Combined use of biopsy and brush cytology yielded higher diagnostic sensitivity (100%). CONCLUSION: Brush cytology is a safe, easy and rapid method of diagnosing gastric malignancies. Brush cytology is a useful adjunct in the diagnosis of gastric malignancies and should be considered a routine method in combination with biopsy. Multiple repeated endoscopies are recommended in cases of positive cytology and negative biopsy to rule out or confirm malignancy.     

Ultrasonic diagnosis of non-Hodgkin's lymphoma]

Analyzes the results of ultrasonic examinations of 111 patients with various forms of non-Hodgkin's lymphomas. Reviews ultrasonic semeiotics of non-Hodgkin's lymphadenopathy of the abdominal cavity and retroperitoneal space and of extranodal variants of lymphoma course (with involvement of the spleen and stomach). Suggests the most safe method for precision diagnostic aspiration biopsy of the spleen monitored by ultrasound. The author considers ultrasonic examination to be a valuable method for the diagnosis of non-Hodgkin's lymphomas; it is economic, rapid, safe, permits a simultaneous assessment of the status of many organs and systems. The results of ultrasonic examinations should be assessed in complex with the results of other diagnostic methods. Ultrasonic examination should be considered as a method of choice for monitoring patients with diagnosed non-Hodgkin's lymphoma.     

血清铜蓝蛋白联合透明质酸检测在肝纤维化患者诊断中的应用

目的 探讨血清铜蓝蛋白(CP)联合透明质酸(HA)检测在肝纤维化患者诊断中的应用前景.方法 选取2015年1月至2018年12月本院收治的疑似肝纤维化患者226例为研究对象,对患者的CP、HA水平进行联合检测,根据各项指标检测水平对患者做出诊断,并与金标准诊断方法肝穿刺活检结果进行对比.对CP、HA单独检测和联合检测的...     

Filtration and agar embedding applied to fine needle aspirates for tumor diagnosis by electron microscopy. A combined technique.

OBJECTIVE: To develop a novel method for processing of fine needle aspirates subjected to electron microscopic (EM) study. STUDY DESIGN: Included 70 cases of poorly differentiated malignant tumors in which a definitive diagnosis was not possible on light microscopic (LM) examination and that thus required application of an ancillary technique such as FNA/EM, for diagnosis. We have established a novel method of processing, a technique of filtration through nylon mesh filters to eliminate red blood cells (RBCs) and necrotic debris, followed by agar well embedding to avoid loss of diagnostic material during processing without centrifugation at later steps after agar embedding, thus minimizing the time required for processing. It was successfully carried out in 70 cases. RESULTS: The combined technique was extremely effective in eliminating RBCs and necrotic debris. It also avoided further loss of valuable diagnostic material. An accurate diagnosis was rendered in 70 cases; that was not possible by LM alone. The whole procedure saves two to three hours of processing as centrifugation is not required after the agar embedding step. CONCLUSION: This technique was found to be cost- and time-effective, particularly suitable for developing countries, where financial resources are limited.     

Combined carcinoembryonic antigen and cytopathologic examination in ascites

OBJECTIVE: To investigate use of the combined carcinoembryonic antigen (CEA) test and cytopathologic examination to improve the diagnosis of neoplastic vs. nonneoplastic ascites. STUDY DESIGN: The tests were performed prospectively on 130 patients with ascites whose effusions were submitted for cytologic examination. RESULTS: Sixty-seven patients had epithelial tumors, and the cytologic examination was positive in 39 (58.2%). The CEA level was > or = 11.0 ng/mL in 36 patients (53.73%). CEA was helpful in the diagnosis in 18 cases, increasing to 57 (85.07%) the number of positive diagnoses. Eight samples of nonepithelial tumors had low levels of CEA. In 55 patients with nonneoplasic ascites the cytopathologic examination was negative, but the CEA assay was > 11.0 ng/mL in 3 patients. CONCLUSION: The cytopathologic examination should be performed in all cases, and the CEA assay should be done in suspected cases of epithelial neoplasia in which the cytologic examination was negative, there was uncertainty about the histologic type of neoplasia, or a diagnosis of nonepithelial neoplasia was made. When ascitic leukocytosis or hepatic failure is present, one should be cautious in interpreting the CEA assay because false positivity can occur.     

INITIAL CARE OF ACUTE BACK INJURIES

The mechanism of injury to the back should be obtained with the utmost accuracy and set down in the history as a separate paragraph under that heading. This is usually best obtained by questioning and requestioning the patient during the course of the examination. A history of any previous back affections should also be obtained at the first visit.The detailed examination of the back is not complete without a general physical examination.X-ray studies should be done immediately in all cases in which the injury has been caused by direct violence or forceful indirect violence (as in “jackknife” injury).Terms such as “disc disease,” “ruptured intervertebral disc” and various others that convey a similar meaning should not be used as the initial diagnosis and should be withheld until such a diagnosis is definitely established.The plan of treatment may include a period in hospital or of rest at home, or it may be carried out with the patient ambulatory. Corsets and braces should be prescribed only when they are to serve a definite function and the same can be said of physiotherapy.     

Needle Biopsy as an Aid to the Precise Diagnosis of Intrathoracic Disease

The place of needle biopsy of the lung and pleura in the diagnosis of intrathoracic disease was assessed by means of an analysis of the results of this procedure in 78 cases involving 111 separate biopsy attempts. The Vim-Silverman needle was used throughout. Needle biopsy of the lung, restricted to cases with localized radiological lesions peripherally situated and suggesting neoplasm, yielded a specific diagnosis in 29 of 48 patients. The comparison with other diagnostic aids, bronchoscopy, sputum cytology and scalene node biopsy, was favourable, at least in the case of peripheral tumours. There were eight complications, only three of which were of significance. Needle biopsy of the pleura proved to be a less rewarding procedure, a specific diagnosis being obtained in only seven of 30 cases. There were, however, no serious complications with this latter procedure. It was concluded that needle biopsy is of some value as a relatively safe addition to diagnostic techniques in chest disease.     

Culdoscopy

Cul-de-sac puncture for introduction of a culdoscope is easily made with the patient in the knee-chest position. With the use of the instrument, the pelvic organs can be viewed clearly. Culdoscopic examination of 45 patients was carried out. In all cases in which laparotomy was done after the examination, the culdoscopic observations and diagnosis were confirmed. In no case in which tubal pregnancy was present, was the diagnosis missed in culdoscopic examination. Patients were only slightly uncomfortable after the examination. There was no evidence of pelvic peritonitis in any patient, and no pregnant patient aborted as a result of the procedure.