The management of ovarian cysts by sono-guided transvaginal cyst aspiration

Nineteen transvaginal, sono-guided ovarian cyst punctures were performed in 18 patients. These patients, who were high surgical risks, were diagnosed to possess benign ovarian tumors as revealed with sonography. Aspiration curettage of the inner surface of the cyst present during aspiration was also performed to facilitate cytologic diagnosis. The recurrence rate was 11.1%. Sono-guided transvaginal cyst aspiration has been demonstrated here to be the treatment of choice for dealing with an ovarian cyst in patients at high surgical risk. © 1993 John Wiley & Sons, Inc.     

Accuracy of mammographic appearances after breast fine-needle aspiration

OBJECTIVE: The objective of this study was to document the observation that fine-needle aspiration of palpable breast masses by use of a modified technique performed shortly before mammography need not adversely interfere with mammographic interpretation nor produce falsely suspicious mammographic lesions that delay meaningful evaluation and management in this breast clinic.STUDY DESIGN: In a retrospective record review 1007 women who were seen in the Breast Diagnostic Center at Women's and Children's Hospital from January 1992 until April 1995 and who had fine-needle aspiration of a palpable solid breast mass within 2 weeks before mammography were analyzed overall and in 10-year age group subsets. The mammographic reports of “suspicious” lesions were correlated with having had a prior fine-needle aspiration (within 2 weeks).RESULTS: Of the 1007 women undergoing fine-needle aspirations, 91 had a cytologic or tissue biopsy specimen diagnosis of malignancy. Of these, 72 had “suspicious” mammograms and 19 had “nonsuspicious” mammograms. The calculated positive predictive value was 58%. The negative predictive value was 98%. Mammographic sensitivity was 79%. Specificity was 94%. Age stratification did not reveal any meaningful trends. Of the 916 patients with benign cytologic results of fine-needle aspiration specimens, 52 had “suspicious” mammograms and 864 had “nonsuspicious” mammograms.CONCLUSION: For patient convenience and expeditious diagnosis of a palpable breast mass, fine-needle aspiration can be performed on the initial visit and mammograms subsequently taken within 2 weeks without undue clinical confusion or misleading mammographic findings. Concordance of the diagnostic triad consisting of (1) clinical impression (by history and examination), (2) fine-needle aspiration, and (3) mammography gives a reliable conclusion and can appropriately be used as the basis for clinical management of a breast mass. However, when there is doubt or anxiety about the diagnosis either on the part of the patient or the physician, a definitive histologic tissue diagnosis should obtained. (Am J Obstet Gynecol 1997;176:1286-92.)     

The lipid laden macrophage index as a marker of aspiration in patients with type I and II laryngeal clefts

Objectives

Laryngeal clefts are uncommon congenital anomalies that may cause pulmonary aspiration, leading to considerable morbidity including recurrent pneumonias. The lipid laden macrophage index (LLMI) is a potential marker of pulmonary aspiration. The objective of this study was to assess the utility of the lipid laden macrophage index as a marker of severity of pulmonary aspiration in children with laryngeal clefts and its role in the management of these patients.

Methods

An institutional review board approved retrospective review of all patients with laryngeal cleft who had also underwent direct laryngoscopy with rigid bronchoscopy and flexible bronchoscopy with bronchoalveolar lavage. The LLMI was measured from the lavage and compared to clinical and radiological data.

Results

Forty-four patients with laryngeal clefts (31 type I clefts and 13 type II clefts) underwent assessment with flexible bronchoscopy and bronchoalveolar lavage. The median age at first outpatient visit in our Center for Aero-digestive Disorder was 0.92 years in patients with type I clefts and 1.66 years in patients with type 2 clefts. All patients in this study had at least one modified barium swallow (MBS) performed to assess for aspiration. The mean LLMI was significantly higher in patients with type II (mean ± SEM) 81.8 ± 11.9 clefts compared to type I clefts 44.9 ± 5.6.

Conclusions

We recommend obtaining LLMI in patients with laryngeal cleft. The lipid laden macrophage index is increased in patients with more severe laryngeal clefts, thus potentially predicting those patients whom would most benefit from early surgical intervention.     

An evaluation of a national intervention to improve the postabortion care content of midwifery education in Nigeria

Objective

To examine the impact of a national intervention to improve the postabortion care (PAC) content of midwifery education in Nigeria.

Methods

A 3-part quantitative assessment was carried out during and post-intervention. The first baseline component developed and examined the intervention to improve teaching capacity and improve the PAC curriculum among 6 midwifery schools that were to become regional training centers. The second survey was a pre- and post-assessment conducted among midwifery instructors from all schools of midwifery in the country. In the third component, 149 midwives graduating from the 6 regional midwifery schools were interviewed once 3-9 months after graduation to evaluate whether the intervention had improved their knowledge of PAC and clinical practice, and the likelihood that they would provide PAC after graduation.

Results

Data from 6 schools of midwifery in 2003 showed that none offered PAC or had educators trained in PAC prior to the intervention. Incorporation of PAC content and teaching capacity increased in all 6 study schools during the 3 years after a national intervention. Midwifery instructors demonstrated statistically significant improvements in knowledge of and exposure to PAC and manual vacuum aspiration (MVA) after the intervention. A follow-up interview with 149 student midwives post graduation showed increased knowledge, exposure to, and use of MVA in the workplace.

Conclusion

Significant changes in graduate midwives' exposure, practice, and provision of PAC services resulted from a national intervention to improve the training environment and skills of midwifery instructors and students in the 6 schools of midwifery selected for evaluation.     

Diagnosing common parotid tumours with magnetic resonance imaging including diffusion-weighted imaging vs fine-needle aspiration cytology: a comparative study

Objectives

The purpose of this study was to evaluate the accuracy of MRI combined with diffusion-weighted imaging (DWI) vs fine-needle aspiration cytology (FNAC) in diagnosing common parotid masses.

Methods

25 consecutive patients (mean age 61 years) with parotid masses were included in this study. Informed consent and ethical approval was obtained. 22 patients underwent both MRI combined with DWI and FNAC. From DWI data, apparent diffusion coefficient maps were generated. The MRI study protocol consisted of T₁ weighted spin echo; T₂ weighted and T₂ weighted fat-suppressed turbo spin echo; DWI; and T₁ weighted fat-suppressed post-contrast images. MRI and FNAC diagnoses were compared with histopathology. Youden''s index was used to compare the two methods.

Results

Masses comprised eight Warthin tumours, eight adenomas (six pleomorphic adenomas, two basal cell adenomas), five carcinomas, two lipomas, one haemagioma and one benign lymphadenopathy. Technically, MRI was successful in 24 of the 25 patients (96%), FNAC was successful in 20 of the 23 patients (87.0%). The accuracy, sensitivity and specificity of MRI without DWI were 96%, 80% and 100%, respectively. Diagnostic accuracy did not increase by adding DWI to conventional MRI; however, DWI was helpful for diagnosing benign tumour histology. MRI combined with DWI was successful for determining accurate tumour typing in all benign masses except one lymphadenopathy. When FNAC had adequate material the accuracy, sensitivity and specificity were 95%, 75% and 100%, respectively. Youden''s index was 0.80 for MRI and 0.75 for FNAC.

Conclusions

MRI combined with DWI seems to have similar diagnostic potential as FNAC in differentiation of benign vs malignant parotid masses.     

The safety of deep sedation without intubation for abortion in the outpatient setting

Study Objective

To determine the rate of perioperative pulmonary aspiration in patients undergoing first and second-trimester surgical abortion during deep sedation with propofol, without intubation.

Design

Retrospective review of cases of surgical and anesthetic complications reported to the Office of Quality Management of the surgical facility between August 1, 2001 and April 30, 2008.

Setting

Large urban surgical abortion outpatient facility.

Measurements

The medical records of all surgical abortion patients who underwent hospital transfer were reviewed. From billing records, all patients who underwent abortion during deep sedation were identified. The primary outcome was the rate of perioperative pulmonary aspiration. Secondary outcomes included the rates of other anesthesia-related adverse events resulting in hospital transfer.

Main Results

During the 81-month study period, the facility performed 62,125 surgical abortions during deep sedation, including 11,039 second-trimester abortions. Only one patient received endotracheal intubation. No cases of perioperative pulmonary aspiration occurred.

Conclusions

Deep sedation without intubation is a viable method of anesthesia for both first and second-trimester surgical abortions in the outpatient setting.     

Correlation between cytology and histopathology of the salivary glam

Background

Salivary gland swellings can result from tumours, an inflammatory process, or cysts. It can sometimes be difficult to establish whether pathology arises from the salivary gland itself or adjacent structures. Fine needle aspiration cytology (FNAC) is a simple, rapid and safe method to diagnose salivary gland swelling. FNAC has high sensitivity, specificity and accuracy. The aims of this study are to correlate FNAC diagnoses with histopathology and to establish the sensitivity and specificity of FNAC in diagnosis of salivary gland swellings in our institution.

Method

The study was conducted in the department of pathology, Sri Venkateshwara Medical college Hospital and research Centre, Pondicherry, India. Data was collected retrospectively for the time period 2007-2008 and prospectively for that obtained between January 2009 and June 2010. Results of cytologicial assessment were compared with histopathological data where possible to establish sensitivity and specificity of FNAC.

Results

During the study period, 1309 FNAC were undertaken of which 96 FNAC were of salivary gland swellings. Correlation of cytology from FNAC with histopathology tissue was possible in 56 cases. Of the 96 cases for which FNAC data was available, 38.56% were from male and 61.45% were from female patients. The age of the patients ranged from 8 to 69 years. 48.95% cases were benign swellings, 13.54% were malignant, 6.25% were cysts and 31.25% had an inflammatory aetiology. Comparison of FNAC findings with histopathology specimens was available for 56 (58.33%) cases, following which the sensitivity and specificity of cytology were found to be 76.9% and 97.1% respectively.

Conclusion

FNAC is highly sensitive and specific technique for diagnosis of most of the salivary gland swelling. FNAC can be used preoperatively to avoid unnecessary surgery and discomfort associated with open biopsy.     

Solid-pseudopapillary pancreatic tumor, mimicking submucosal tumor of the stomach: A case report

Solid-pseudopapillary tumors of the pancreas(SPTs) are comparatively rare and have low malignancy,with a predilection for young women.Diagnosis is difficult when a SPT develops in a boundary region with other organs.Here,we report a 42-year old woman with a SPT of the pancreas mimicking a submucosal tumor of the stomach on imaging.She was admitted to our hospital complaining of abdominal pain.We suspected a submucosal tumor of the stomach from the f indings of endoscopy,endoscopic ultrasonography and abdominal computed tomography.However,angiography showed that some of the tumor vessels arose from the pancreas.Intraoperative f indings revealed the tumor originated from the pancreas.Therefore,distal pancreatectomy was performed.The pathological diagnosis was SPT of the pancreas.