胸腔镜与经皮胸膜活检在胸腔积液诊断中的临床价值

目的比较内科胸腔镜和经皮胸膜活检在胸腔积液诊断中的价值。方法分析我院同期开展内科胸腔镜(胸腔镜组)和经皮胸膜活检(闭式活检组)的胸腔积液患者,比较两组的病理诊断阳性率及安全性。结果胸腔镜组病理诊断阳性率显著高于闭式活检组,胸腔镜组恶性肿瘤诊断率显著高于闭式活检组,胸腔镜组胸膜结核的诊断率与闭式活检组无显著性差异;两组并发症比较无显著性差异。结论经皮胸膜活检和内科胸腔镜对于胸腔积液诊断均是安全、有效的方法。     

Pleural biopsies: complications and current value of Abram's needle biopsy. Apropos of 1,000 samples. Value of pleuroscopic biopsy]

The frequency of incidents resulting from Abrams needle biopsy is very low provided certain contraindications are respected : pneumothorax, 3.1% of cases ; hemorrhages, 1.3% ; neoplastic contamination of the bioptic tract, 1.9%. Serious accidents are rare. We only observed 2 serious hemorrhages, one in 1964, the other in 1968. In the latter case, the pleural hemorrhage caused a very serious respiratory insufficiency. The delayed functional reaction is still not well known. However the occurrence of immediate accidents could reflect on radiological sequelae. The value of this examination seems today to decrease slightly at the same time as the frequency of pulmonary tuberculosis decreases. Indeed pulmonary tuberculosis is the main indication for this method because of the history and because of the possibility of culture on Loewenstein medium. In cancer, needle biopsy has two drawbacks, that of being blind and yielding only small samples, while pleuroscopy is free of them. In a series of 77 examinations including 45 cancers, the positivity reached 80%. In only 2 cases did pleuroscopy give a falsely positive result. In the remaining cases there was no neoplastic invasion of the pleura.     

Adenosine deaminase activity in the diagnosis of lymphocytic pleural effusions of tuberculous,neoplastic and lymphomatous origin

We studied the activity of adenosine deaminase in 74 lymphocytic pleural effusions which were divided into four groups according to the aetiology: tuberculous (38 cases), neoplastic (17), lymphomatous (7) and miscellaneous (12). The mean enzyme value was significantly higher in the tuberculous cases (93.81±29.56 U/I) than for the other three groups and significantly higher in pleural effusions of lymphomatous origin than in the neoplastic and miscellaneous groups. Based on the lowest value of enzyme activity found in the tuberculous group (50 U/I), the test had a sensitivity of 1 and a specificity of 0.97.     

Investigation of pleural effusion: comparison between fibreoptic thoracoscopy, needle biopsy and cytology

Twenty-eight patients with exudative pleural effusion have been investigated by fibreoptic thoracoscopy, Abrams needle biopsy and pleural fluid cytology. Sixteen patients had previously had negative pleural biopsies and cytology. Twenty effusions were malignant (16 mesothelioma, four metastatic carcinoma), seven were due to nonspecific inflammation and in one case no abnormality was found. The diagnostic yield for all three techniques combined was 85%, for thoracoscopy alone 65%, Abrams biopsy 60% and cytology 45%. In 12 patients presenting without previous investigation all eight malignant effusions were correctly diagnosed by at least one of the techniques with individual sensitivities of 75% for thoracoscopy, 63% for Abrams and 38% for cytology. Of the 16 patients who had previously had negative investigations 12 had malignant effusions, nine (75%) of which were diagnosed by a combination of the techniques. In this group, the individual sensitivities were 58% for both thoracoscopy and Abrams and 50% for cytology. A correct diagnosis of malignancy was made by a combination of needle biopsy and cytology in 75% of patients with previous investigations and 88% of those without. Fibreoptic thoracoscopy added only two diagnoses of malignancy to those obtained by Abrams and cytology. The limitations of the technique render it unsuitable for routine investigation of pleural effusions.     

Prospective study comparing the results obtained by liver puncture biopsy with Chiba fine needle and Menghini needle in some tumors of the liver

Seventy-eight consecutive patients (mean age 59 years) have been submitted to concomitant liver biopsy with Menghini and Chiba needles. The same place in the liver was reached by both needles. In 54 cases there was a clinical suspicion of malignancy and in 24 patients biopsy was indicated by other reasons. In 60 cases the biopsies were oriented by laparoscopy. Comparing the results attained by Menghini needle ("gold standard") and the results of the cytologic study of the material obtained with Chiba needle, the last method has proved to be sensible (92.7%), specific (97.3%) and reliable (accuracy = 94.9%).     

Ultrasound-guided biopsies of abdominal organs with an automatic biopsy system. A retrospective analysis of the quality of biopsies and of hemorrhagic complications

BACKGROUND: Ultrasound-guided biopsies of abdominal organs are not without risks for the patients; in particular, hemorrhagic complications may occur. Thus, over the last few years, automatic biopsy guns have been developed to facilitate the biopsy process. METHODS: The aim of our retrospective study was to examine the quality of specimens and the complication rate of ultrasound-guided biopsies of abdominal organs carried out in our institution using the automatic Autovac biopsy system during a period of 1.5 years. Of the total number of 321 biopsies, 290 were performed with the 1.2-mm Autovac needle, and in 31 cases the 0.95-mm needle was used. Among the 321 biopsies there were 211 of the liver parenchyma (66%), 47 of a liver tumor (14%), 38 of the pancreas (12%), 15 of the kidney parenchyma (5%), and 10 of a retroperitoneal tumor (3%). RESULTS: In 310 of the 321 biopsies it was possible to obtain sufficient diagnostically usable material for the pathologist (96.6%). In the other 11 cases the material obtained did not enable proper histologic diagnosis (3.4%). Two of these 11 biopsies were carried out with the 0.95-mm needle, and the other 9 with the 1.2-mm needle. Twenty-four hours after the biopsy each patient underwent routine ultrasound examination to exclude a possible bleeding. In eight cases an afterbleeding occurred (total hemorrhagic rate, 2.5%), four times without clinical consequences. The other four bleeding complications were more serious (1.2% of all taps), and all occurred after liver biopsies in patients with a history of liver complaints and abnormal clotting variables. There were no fatalities among our biopsies (mortality rate, 0%). CONCLUSION: The automatic Autovac biopsy system is suitable and relatively safe for obtaining sufficient histopathologic material from intra-abdominal organs.     

经支气管镜针吸结合刷片和钳夹活检在支气管壁内和管壁外恶性病变的诊断价值

目的探讨经支气管镜针吸与刷片和钳夹活检技术联合,对支气管壁内和管壁外恶性病变进行病理取材的诊断价值。方法在胸部CT提示肺门、纵隔淋巴结肿大(大于1cm)合并肺部病变、纵隔肿物的32例患者,予常规纤维支气管镜检查经支气管镜针吸活检(TBNA)术并行刷检和钳检,对获取的标本进行细胞学及组织病理学检查。结果 32例最终均确诊为胸部恶性肿瘤,经支气管镜针吸活检(TBNA)、刷检、钳检的阳性检出率分别为59.4%、65.5%和40.0%,三者联合取材的阳性率84.4%(趋势检验χ~2=6.0,P值0.05)。所有患者均无明显的并发症。结论联合取材的方法安全、方便,还具有创伤小,阳性率高等优点,对胸部恶性肿瘤的诊断和分期判定有很大帮助。     

Ultrasound-guided fine-needle biopsy of focal liver lesions: techniques, diagnostic accuracy and complications. A retrospective study on 2091 biopsies

Two thousand and ninety-one ultrasound-guided fine-needle biopsies were performed in 1946 patients to diagnose focal liver lesions. The diagnostic accuracy of fine-needle biopsies is very high (only one false positive was observed), both for aspiration biopsy (93.4%) and for cutting biopsy (95.1%). The difference is not statistically significant. In cases of hepatocellular carcinoma (but not in cases of metastasis or hepatic lymphoma), double biopsy (aspiration and cutting) showed higher diagnostic sensitivity than single methods. A certain number of benign focal liver lesions were also diagnosed. In the present series, no case of death following liver puncture was observed. Intraperitoneal hemorrhage was the most common complication. The risk with a cutting needle being higher than with an aspirative needle.     

Immunohistochemical studies on non neoplastic and neoplastic gastric mucosa. Determination of embryonic and specific antigens (author's transl)]

The distributions of acid alpha1-glycoprotein, alpha1-fetoprotein, beta-galactosidase and gastrin in gastric carcinoma and gastric ulcer as well as in the neighbourhood of these lesions were studied by means of immunohistochemical methods on imprint preparation. We could not find significant differences between gastric carcinoma and the nonneoplastic lesions, except for the acid alpha1-glycoprotein. The results of this first study indicate that the immunochemical and immunohistological assay of acid alpha1-glycoprotein might be of practical value in diagnosing malignant changes of gastric mucosa.     

Corrected transposition of the great vessels and preexcitation syndrome (apropos of 2 cases)]

Two cases with treated transposition of the great vessels and incompetence of the left atrioventricular valve showed a type B preexcitation syndrome. In one case, this consisted of a typical W.P.W. syndrome in which the second PR interval was not shortened, but rather consisted of a delta wave and a widened QRS complex. Post mortem examination showed an abnormal connection between the bundle of His and the ventricular septum, and a low insertion of the inverted tricuspid valve. The published cases of W.P.W. syndrome in cases with treated transposition are reviewed, and the mechanism of preexciation discussed in the light of the anatomical peculiarities of the malformation and of the abnormalities which are a feature of Ebstein's syndrome.