scholarly journals Triple Cultures Increase the Diagnostic Sensitivity of Mycobacterial Tuberculosis Empyema

2017 ◽  
Vol 2017 ◽  
pp. 1-4
Author(s):  
Kingsfield Ong ◽  
Keerthi Rajapaksha ◽  
Chin Siang Ong ◽  
Ali Akbar Fazuludeen ◽  
Aneez Dokeu Basheer Ahmed
Keyword(s):  
Tissue Culture ◽  
Pleural Fluid ◽  
Diagnostic Yield ◽  
Surgical Complication ◽  
Granulomatous Inflammation ◽  
Diagnostic Approach ◽  
The Novel ◽  
Diagnostic Practices ◽  
Prolonged Air Leak ◽  
Pleural Tissue

Background. There is a continuous debate on the appropriate diagnostic approach and surgical management of mycobacterial empyema, with widely varied diagnostic practices and surgical outcomes. The aim of this study is to highlight the diagnostic approach and clinical features of patients who required surgical intervention for mycobacterial empyema.Methods. We performed a 5-year retrospective cohort study of all patients with mycobacterial empyema requiring surgery in a single institution from November 2009 to November 2014.Results. Eighteen patients (15 males and 3 females, median age 48.5 years) required surgery. Seventeen patients required decortication via posterolateral thoracotomy and one patient underwent video-assisted thoracic surgery drainage and pleural debridement. Prolonged air leak was the commonest surgical complication (50%,n=9). 94.4% (n=17) had necrotizing granulomatous inflammation on histological examination. The sensitivity of mycobacterium smear and culture ranged between 12.5% and 75% for pleural tissue, sputum, and pleural fluid individually. The combination of all 3 samples increased the diagnostic yield to 100%.Conclusion. With the implementation of pleural tissue culture at surgery, the novel combination of sputum, pleural fluid, and pleural tissue culture provides excellent diagnostic yield.

scholarly journals Diagnostic Value of Flexible Thoracoscopy in Undiagnosed Cases of Exudative Pleural Effusion

2020 ◽  
Vol 7 (47) ◽  
pp. 2783-2786
Author(s):  
Vengada Krishnaraj S.P. ◽  
Gayathri S. Mohan ◽  
Vinod Kumar V ◽  
Sridhar R
Keyword(s):  
Pleural Effusion ◽  
Pleural Fluid ◽  
Complete Blood Count ◽  
Diagnostic Yield ◽  
Diagnostic Value ◽  
Parietal Pleura ◽  
Pleural Biopsy ◽  
Cardiac Evaluation ◽  
Exudative Pleural Effusion ◽  
Fluid Cytology

BACKGROUND The diagnostic yield of thoracoscopy is 95 %, of pleural fluid cytology it is 62 % and of closed pleural biopsy is 44 %, in malignant effusion. We wanted to study the diagnostic utility of flexible thoracoscopy in undiagnosed exudative pleural effusion and compare the thoracoscopy findings with the histopathology results. METHODS The study was conducted in the Department of Respiratory Medicine, Government Stanley Medical College, Chennai, from January 2019 to January 2020. 40 patients were enrolled in this longitudinal observational study with moderate to massive effusion and were evaluated with pleural fluid aspiration and sent for cytology, protein sugar analysis, total count, and ADA. Those cases which are exudative pleural effusions, with ADA value of less than 40 IU / L were subjected to thoracoscopy after being evaluated for fitness for thoracoscopy with complete blood count, bleeding time, clotting time, sputum for AFB, ECG, pulse oximetry, cardiac evaluation and CT chest. RESULTS Thoracoscopy was done in 40 enrolled patients. In this study, biopsy was taken from the parietal pleura in all the cases. Of these 40 cases, 30 were male and 10 were female, that is 75 % males and 25 % females. The mean age of the study population was 43 ± 14.9. Patient with the lowest age in this study group was 18 years and highest was 71 years. 16 cases (40 %) presented with left sided pleural effusion. 24 cases (60 %) presented with right sided pleural effusion. 30 cases presented with massive effusion, and 10 cases with moderate effusion. Of the 40 cases, 27 cases presented with straw coloured pleural effusion. 13 cases were haemorrhagic effusion. Histopathologic examination showed 11 cases as malignant and 29 cases as non-malignant out of which 18 cases were of tuberculosis aetiology. Thoracoscopy revealed adhesions in 13 cases and mass lesion in 4 cases. Of the 4 mass lesions 3 came as malignant, normal pleura in 11 cases, 10 were non-malignant and 1 was malignant. Nodules were seen in 12 cases of which 7 came as malignant. Straw coloured effusion was seen in 27 cases, of which 2 were malignant. CONCLUSIONS The most important indication for thoracoscopy is exudative undiagnosed pleural effusion. The overall diagnostic yield in pleural fluid cytology is 62 % and blind pleural biopsy is 44 %. The diagnostic yield of thoracoscopy varies from 60 % to 97 % in various studies, whereas, in our study, it is 72.5 %. Visualization of the visceral and parietal pleura is another advantage, so that we can take biopsy from the abnormal areas. KEYWORDS Flexible Thoracoscopy, Undiagnosed Exudative Pleural Effusion

scholarly journals The value of exfoliative cell cytology in the diagnosis of exudative pleural effusions

2018 ◽  
Vol 88 (3) ◽  
Author(s):  
Cuneyt Tetikkurt ◽  
Nail Yılmaz ◽  
Seza Tetikkurt ◽  
Şule Gundogdu ◽  
Rian Disci
Keyword(s):  
Pleural Effusion ◽  
Pleural Fluid ◽  
Diagnostic Yield ◽  
Final Diagnosis ◽  
Exfoliative Cytology ◽  
Pleural Effusions ◽  
Cytologic Examination ◽  
Collagen Vascular Diseases ◽  
Female Ratio ◽  
Exudative Pleural Effusion

The sensitivity and specificity of exfoliative cell cytology for the diagnosis of exudative pleural effusions varies widely according to the etiologic causes. The aim of this study is to assess the diagnostic value of exfoliative cell cytology for the identification of exudative pleural effusions. This is a retrospective study of the patients with an exudative pleural effusion admitted at our clinic in the last twenty years. We have conducted the clinical, the cytological findings, and the diagnostic results of six hundred patients from hospital records.  Male to female ratio was 2.2:1 with a mean age of 42.8 years (range 18-78 years) among the patients. Samples were processed and evaluated according to the standard methods. Cytology results were reviewed and the patients were stratified according to the final diagnosis of their disease. Of the six hundred exudative effusions, 240 were malignant on exfoliative cytology pleural fluid alone. Adenocarcinoma was the most common type of malignancy. Tuberculosis was the second most frequent etiology for the exudative effusions followed by infection and collagen vascular diseases. Diagnostic accuracy of cytology showed a good correlation with the final diagnosis with an overall 70.1% sensitivity, 62.5% specificity, and a 95.9% positive predictive value for all exudative pleural effusions. Cytologic examination of the pleural fluid is a simple non-invasive procedure as the initial step for the diagnostic work up of patients with a pleural effusion.  Exfoliative cytology provides high a final diagnostic yield for the identification of an exudative pleural effusion etiology. Furthermore, cytologic analysis leads the clinician into the correct diagnostic pathway as the most informative laboratory tool even when it was not diagnostic by itself for equivocal cases.

P2790Novel endomyocardial micro-biopsy device for higher precision and reduced complication risks

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A Chireh ◽  
R Grankvist ◽  
M Sandell ◽  
A K Mukarram ◽  
N Jaff ◽  
...  
Keyword(s):  
Endomyocardial Biopsy ◽  
Diagnostic Yield ◽  
Molecular Data ◽  
Outer Diameter ◽  
The Novel ◽  
Rna Seq ◽  
Device Design ◽  
Biopsy Device ◽  
Different Parts

Abstract Introduction Endomyocardial biopsy (EMB) is the gold standard for diagnosis of several cardiac diseases, yet its use is limited by low diagnostic yield and significant complication risks. The size of the current devices allows only limited steering to different parts of the ventricle walls. In transplant monitoring, repeated biopsies with the current devices can cause scarring that makes it increasingly difficult to obtain adequate samples. We hypothesised that several of the shortcomings of EMB can be avoided with a smaller and more steerable device. Further, we hypothesised that the novel sampling procedure could be coupled to a low-input molecular analysis method, such as RNA-sequencing (RNA-seq), to provide molecular characterisation of the tissue without the need of large biopsy samples. Purpose To develop an EMB device with significantly smaller dimensions, for future use in diagnostics and research investigations. Specific aims were to test feasibility and safety of the procedure, as well as the quality of the generated molecular data. Methods 65 “micro biopsy” (micro-EMB) device prototypes were designed and evaluated in-house. The prototypes were evaluated either in an ex-vivo simulator or in acute non-survival pig experiments (n=23). Once the final device design was reached, an in vivo trial was set up using six naive Yorkshire farm pigs. Micro-EMB, conventional EMB, skeletal muscle and blood samples were collected for RNA-seq characterisation and comparison. In half of the animals (n=3), micro-EMB was the only intervention in order to prioritise safety evaluations. The animals were monitored for one week. Results The final device design has an outer diameter (OD) of 0.4 mm, compared to a conventional 11 mm device (in the opened position), Fig 1A. The device can be directed to different parts of the myocardium in both ventricles. In the in vivo evaluation in swine, 81% of the biopsy attempts (n=157) were successful. High quality RNA-seq data was generated from 91% of the sequenced heart micro-biopsy samples (n=32). The gene expression signatures of samples taken with the novel device were comparable with samples taken with a conventional device, Fig 1B. No major complications were detected either during periprocedural monitoring or during the follow-up. The tissue mark after micro-biopsy was markedly smaller than after conventional endomyocardial biopsy. A) Bioptome dimensions. B) RNA-seq data. Conclusions Our preliminary data suggest that the novel submillimeter biopsy device, coupled with RNA-seq, provides a feasible method to obtain molecular data from the myocardium. The method is less traumatic and has a higher flexibility compared to conventional methods, enabling safer and more specific sampling from different parts of the myocardium. In the long term, the procedure could open unprecedented diagnostic and research possibilities. Future studies should be directed to establish the capabilities of the novel method in a relevant disease model. Acknowledgement/Funding Family Erling Persson Foundation. The Söderberg foundations. KID (Karolinska Institutet). The 4D project. Stockholm county council. Astra Zeneca.

scholarly journals Pleural tuberculosis

2016 ◽  
Vol 65 (1) ◽  
Author(s):  
B. Chakrabarti ◽  
P.D.O. Davies
Keyword(s):  
Pleural Fluid ◽  
Diagnostic Yield ◽  
Western World ◽  
Pleural Effusions ◽  
Pleural Biopsy ◽  
Biopsy Specimens ◽  
Tuberculous Pleurisy ◽  
The Impact ◽  
Antituberculous Chemotherapy

Pleural effusions in tuberculosis are commonly seen in young adults as an immunological phenomenon occurring soon after primary infection. However, the epidemiology and demographics of tuberculous pleurisy are changing due to the impact of HIV co-infection and the increasing number of pleural effusions seen as part of re-activation disease. Pleural biopsy for histology and culture is the mainstay of diagnosis with closed needle biopsy adequate in the majority of cases. Techniques such as PCR of biopsy specimens and the role of pleural fluid ADA are still being evaluated as a diagnostic aid. Tuberculous empyema is less commonly seen in the western world and the diagnostic yield from pleural fluid here is greater than in “primary” effusions. Treatment with appropriate antituberculous chemotherapy is generally successful though there is currently insufficient evidence to recommend the routine use of corticosteroids in this condition.

scholarly journals Ideal implant choice for proximal interphalangeal joint arthrodesis in hammer toe/claw toe deformity correction: A systematic review

2020 ◽  
Vol 28 (1) ◽  
pp. 230949902091116
Author(s):  
Rachel XY Wei ◽  
Samuel KK Ling ◽  
TH Lui ◽  
Patrick SH Yung
Keyword(s):  
Systematic Review ◽  
Surgical Complication ◽  
Deformity Correction ◽  
Proximal Interphalangeal Joint ◽  
Interphalangeal Joint ◽  
Complication Rates ◽  
The Novel ◽  
Claw Toe ◽  
Hammer Toe ◽  
K Wires

Intramedullary devices have been developed to reduce the problems associated with Kirschner (K)-wire fixation in proximal interphalangeal joint (PIPJ) arthrodesis. The purpose of this systematic review is to compare the surgical outcomes of K-wires versus novel internal fixation devices in PIPJ arthrodesis in claw/hammer toe surgery. The databases searched were PubMed, Scopus, Cochrane, and Embase with keywords “claw toe OR hammer toe” AND “proximal interphalangeal OR PIP” AND “fusion OR arthrodesis.” Clinical trials published in English with evidence levels I, II, and III were included. Five studies, including one randomized controlled trial and four case-controlled studies, were identified to meet the inclusion criteria. Overall, the studies showed promising results in union rates using the novel internal devices compared to K-wires. However, the novel internal devices seem not to present advantages in clinical parameters such as pain levels, patient satisfaction, foot-related function, or surgical complication rates.

Percutaneous Image-Guided Biopsy of the Spleen

2018 ◽  
Vol 02 (02) ◽  
pp. 101-105
Author(s):  
Alda Tam ◽  
Sharjeel Sabir
Keyword(s):  
Diagnostic Yield ◽  
Diagnostic Approach ◽  
Solid Organ ◽  
Appropriate Use ◽  
Image Guided ◽  
Guided Biopsy ◽  
Optimum Technique ◽  
Splenic Biopsy

AbstractPercutaneous spleen biopsy has a small but important role in the diagnostic approach to splenic lesions. Nonetheless, there remain concerns about the safety of the procedure, limiting its use despite evidence that splenic biopsy performed with optimum technique has comparable diagnostic yield and safety as other solid organ biopsies. To assure appropriate use of percutaneous image-guided spleen biopsy, we discuss the rationale, technique, and outcomes of the procedure.

Ultrasound-Guided Fine-Needle Aspiration Cytology of Non-Palpable Supraclavicular Lymph Nodes in Sarcoidosis

1996 ◽  
Vol 37 (3P2) ◽  
pp. 896-899 ◽  
Author(s):  
P. Lohela ◽  
T. Tikkakoski ◽  
L. Strengell ◽  
S. Mikkola ◽  
S. Koskinen ◽  
...  
Keyword(s):  
Lymph Nodes ◽  
Fine Needle Aspiration ◽  
Diagnostic Yield ◽  
Granulomatous Inflammation ◽  
Needle Aspiration ◽  
Diagnostic Methods ◽  
Aspiration Cytology ◽  
Cytological Evidence ◽  
Fine Needle ◽  
Supraclavicular Lymph Nodes

Purpose: The aim of this prospective study was to determine the incidence of enlarged supraclavicular lymph nodes by US and the diagnostic yield of US-guided aspiration cytology in the diagnosis of sarcoidosis. Methods: During a 54-month period, all consecutive patients with a clinical suspicion of sarcoidosis underwent supraclavicular US at the Kiljava Hospital, Finland. All patients with enlarged supraclavicular lymph nodes underwent US-guided fine-needle aspiration biopsy (FNAB) of the lymph node. Results: Of a total of 250 patients, 27 (10.8%) had enlarged supraclavicular lymph nodes at US. All these were non-palpable at clinical examination. The cytological specimen was quantitatively sufficient in 25 of the 27 cases (93%). In 22 (88%) of these, the cytological diagnosis was granulomatous inflammation suggestive of sarcoidosis. Three aspirates yielded reactive hyperplasia and 2 specimens were insufficient. No complications occurred. The patients were followed for 2–42 months (mean 19 months), and the diagnosis of sarcoidosis was confirmed clinically in all cases. Conclusion: Supraclavicular US detects non-palpable enlarged lymph nodes in 1/10 of the patients with suspected sarcoidosis. In this subgroup of patients, US combined with aspiration cytology may give cytological evidence of granulomatous disease similar to sarcoidosis and more invasive diagnostic methods can be avoided.

scholarly journals Pooling of samples to optimize SARS-CoV-2 diagnosis by RT-qPCR: comparative analysis of two protocols.

2020 ◽  
Author(s):  
Fabiana Volpato ◽  
Daiana Lima-Morales ◽  
Priscila Lamb Wink ◽  
Julia Willig ◽  
Fernanda de-Paris ◽  
...  
Keyword(s):  
Large Scale ◽  
Diagnostic Yield ◽  
Rna Extraction ◽  
Clinical Samples ◽  
The Novel ◽  
Positive Individual ◽  
Sample Pooling ◽  
Novel Coronavirus ◽  
The Individual ◽  
Pooled Samples

RT-qPCR for SARS-CoV-2 is the main diagnostic test used to identify the novel coronavirus. Several countries have used large scale SARS-CoV-2 RT-qPCR testing as one of the important strategies for combating the pandemic. In order to process the massive needs for coronavirus testing, the usual throughput of routine clinical laboratories has reached and often surpassed its limits and new approaches to cope with this challenge must be developed. This study has aimed to evaluate the use pool of samples as a strategy to optimize the diagnostic of SARS-CoV-2 by RT-qPCR in a general population. A total of 220 naso/orofaryngeal swab samples were collected and tested using two different protocols of sample pooling. In the first protocol (Protocol A); 10 clinical samples were pooled before RNA extraction. The second protocol (Protocol B) consisted of pooling the already extracted RNAs from 10 individual samples. Results from Protocol A were identical (100% agreement) with the individual results. However, for results from Protocol B, reduced agreement (91%) was observed in relation to results obtained by individual testing. Inconsistencies observed were related to RT-qPCR results with higher Cycle Thresholds (Ct > 32.73). Furthermore, in pools containing more than one positive individual, the Ct of the pool was equivalent to the lowest Ct among the individual results. These results provide additional evidence in favor of the clinical use of pooled samples for SARS-CoV-2 diagnosis by RT-qPCR and suggest that pooling of samples before RNA extraction is preferrable in terms of diagnostic yield.

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