Impact of rapid on-site cytologic evaluation during transbronchial needle aspiration

STUDY OBJECTIVE: To determine the extent to which rapid on-site cytologic evaluation (ROSE) of transbronchial needle aspiration (TBNA) samples can safely and cost-effectively reduce the need for additional biopsy during bronchoscopy. SETTING: University Hospital in Long Island, NY. PATIENT AND METHODS: Forty-four bronchoscopies with TBNA, most of which utilized ROSE, were evaluated prospectively. The number and types of biopsies performed during each procedure were compared to a preprocedural algorithm to determine the impact of knowing ROSE results during the procedure. Bronchoscopies performed with and without ROSE were compared, as were bronchoscopies with diagnostic and nondiagnostic ROSE results. A cost analysis was performed comparing the Medicare reimbursement for ROSE to the savings of deferring multiple biopsies. RESULTS: Thirty-two bronchoscopies were performed with ROSE; 12 were performed without ROSE. Fewer biopsies were performed during bronchoscopies utilizing ROSE. Diagnostic yield, TBNA sensitivity and accuracy, and procedural time were similar between these two groups. CONCLUSIONS: ROSE during TBNA allows for deferring additional biopsy without loss in diagnostic yield, likely lowers procedural risk, and is cost-effective.     

Organ-sparing surgical treatment of giant hepatic hydatid cysts

BACKGROUND: Excision of giant hepatic hydatid cysts may be associated with loss of hepatic tissue. We describe a method for obliterating spacious residual cavities that promotes salvage of healthy liver parenchyma. METHODS: After simple cystectomy, the residual cavity is obliterated by manual compression of the healthy liver parenchyma from the left and right toward the midline of the cavity. While compression is maintained, the approximated edges of the cyst's fibrous capsule are closed with mattress sutures. Omentoplasty or gelatine sponges are used to fill the dead space prior to suturing of the fibrous capsule. RESULTS: The method was used in 8 patients between 1993 and 2000. No sepsis, postoperative bile leak, or other complications occurred. No long-term adverse effects were found. CONCLUSIONS: This method is simple and effective for obliteration of extremely large residual cavities after cystectomy for liver hydatidosis. It may be used safely in selected patients.     

Recurrent intercostal herniation of the liver

Abdominal intercostal hernia occurs rarely, with only 26 previous cases reported in the professional literature. A 51-year-old man presented with a painful right chest protrusion. One year earlier he had experienced a severe coughing spell and spontaneous rib fracture and chest protrusion. He was treated with endogenous tissue reinforcement and had no clinical improvement. Magnetic resonance imaging revealed the liver protruding through the chest wall. The hernia was reduced and the chest wall was repaired with prosthetic mesh and cables. Attention to the chest wall anatomy and reliable tissue closure including pericostal or transcostal nonabsorbable sutures and a prosthetic bridge over the defect are the best way to eliminate the patient's risk for recurrence.