Surgical treatment of posterior fossa tumors in infancy and childhood: techniques and results

Fetal/neonate kidneys obtained at the time of autopsy were utilized to determine a suitable needle biopsy gauge to obtain renal parenchyma for histologic evaluation. Twenty-one fresh kidney specimens from 11 fetuses/neonates between 16-40 weeks gestation were used to obtain needle biopsies using 20-, 18-, 16-, and 14-gauge biopsy catheters. The specimens were graded according to the presence of normal histologic features of renal parenchyma. Seventy-five renal biopsies were obtained. The biopsy histology was interpreted using a grading system based on the presence of normal features of the renal parenchyma. Sixty-three (84%) of the samples were graded histologically as adequate (cortex or medulla present). Samples with both cortex and medullary structures present (completely adequate) were obtained in 39/63 (62%) of these adequate biopsies. The 14- and 16-gauge biopsy catheters gave the best results, respectively yielding 79 and 69% completely adequate biopsies. This is in contrast to the 20- and 18-gauge catheters that respectively yielded 35 and 25% completely adequate biopsies. Our initial results indicate that adequate kidney biopsies can be obtained. However, the current technique is associated with core sample disruption when the smaller gauge catheters are used. This could account for the low rate of completely adequate samples with the smaller gauge catheters. A different sampling technique is needed to overcome sample disruption, to determine the smallest catheter gauge that will yield a suitable tissue sample for histologic evaluation.     

Pathomorphological study of HCV antibody-positive liver cirrhosis

A morphological investigation was carried out to study the pathological features of liver cirrhosis caused by hepatitis C virus (HCV) infection. The materials consisted of liver specimens taken from 47 cases of anti-HCV antibody-positive liver cirrhosis (37 by surgery for hepatocellular carcinoma and 10 by autopsy), and from 21 cases of hepatitis B surface antigen-positive liver cirrhosis as the control. Liver specimens containing more than 10 regenerative nodules were examined. In addition, a histometric study was conducted to determine the degree of fibrosis and the size of regenerative nodule using a computer image-analysis system. The results showed that the histological characteristics of HCV antibody-positive liver cirrhosis are: (i) broadly expanded fibrous septa and small regenerative nodules; (ii) relatively strong inflammatory reaction and prominent lymphoid aggretation in the fibrous septum; and (iii) mild regenerative activity of the liver parenchyma, and infrequent liver cell dysplasia. These findings may facilitate better understanding of the pathology of HCV antibody-positive liver cirrhosis and more accurate pathological diagnosis by needle biopsy.     

Predictive value of specimen radiography for core needle biopsy of noncalcified breast masses

OBJECTIVE: Our objective was to determine the predictive value of specimen radiography for large core (14-gauge) needle biopsy of noncalcified breast masses. SUBJECTS AND METHODS: Eighty-four biopsies of 83 breast masses yielded 403 specimens. Specimens showing dense material on specimen radiography were predicted to be diagnostic; specimens showing intermediate- or low-density material were predicted to be nondiagnostic. Specimen radiographic and histopathologic findings were correlated for each specimen using vital dyes to mark individual specimens. RESULTS: Of the 403 specimens, 307 (76%) contained diagnostic material representative of the lesion, with a specific diagnosis achieved for 82 (99%) of 83 lesions (62 benign, 20 malignant). Of the 293 passes containing dense material, 268 (91%) proved to be diagnostic; 11 (18%) of 62 specimens containing only low-density material proved to be diagnostic. Of the 25 (9%) of 293 specimens containing radiographically dense but nondiagnostic material, 18 (72%) showed focal fibrosis and had missed the lesion; 15 (83%) of 18 such specimens were obtained in dense parenchyma. The positive predictive value of specimen radiography was 13 (100%) of 13 in fatty breasts; 77 (96%) of 80 in breasts with minimal scattered fibroglandular elements; 91 (94%) of 97 in heterogeneously dense breasts; and 35 (70%) of 50 in breasts with extremely dense parenchyma. Of the 16 lesions sampled stereotactically, specimen radiography helped assess the inadequacy of initial sampling in three (19%). In six (9%) of 68 sonographically guided biopsies, only one or two specimens could be obtained; specimen radiography helped us predict whether material was adequate for diagnosis. CONCLUSION: Radiography of core specimens obtained from noncalcified breast masses accurately reveals the adequacy of sampling unless the breast parenchyma is extremely dense. Such immediate assessment can help ensure adequate material from lesions that are difficult to biopsy and can thereby improve the diagnostic yield of large core needle breast biopsy.     

Imaging the ''dirty lung''--has high resolution computed tomography cleared the smoke?

RATIONALE AND OBJECTIVES: The objective was to analyze if liver enhancement with mangafodipir trisodium was influenced by liver cirrhosis. METHODS: Eighty patients (49 with cirrhotic and 31 with noncirrhotic livers) were studied with spin-echo and spoiled gradient-echo T1-weighted images, before and after administration of mangafodipir trisodium. Hepatic insufficiency was assessed using the Child classification. Image analysis was performed both qualitatively and quantitatively. RESULTS: Noncirrhotic livers enhanced homogeneously but 37% of cirrhotic livers did not; the difference was significant. Areas corresponding to collapsed fibrous zones enhanced less than the rest of the parenchyma; areas of regenerating nodular zones enhanced more. Signal-to-noise ratios were significantly less for cirrhotic livers on postcontrast spoiled gradient-echo images. Cirrhotic livers had significantly lower relative enhancement ratios than noncirrhotic ones. The Child index and aspartate aminotransferase values were statistically related to the enhancement ratio. CONCLUSIONS: Mangafodipir trisodium enhancement in cirrhotic livers is related to necrosis and regeneration of the hepatocytes. Cirrhotic livers enhanced less than noncirrhotic ones.     

Diagnosis of prostate carcinoma on biopsy specimens improved by basal-cell-specific anti-cytokeratin antibody (34 beta E12)

The identification of basal cells by the basal-cell-specific anti-cytokeratin antibody 34 beta E12 has been shown to be useful in the diagnosis of prostate carcinoma. To determine the usefulness of 34 beta E12 in prostate biopsies we examined formalin-fixed needle biopsy specimens. In a 17-month period 796 prostate needle biopsies obtained from 293 patients were evaluated on hematoxylin and eosin stains; all 796 biopsy specimens were immunostained as well. Immunostaining with 34 beta E12 reduced the rate of equivocal cases from 5.1% to 1.0% and additionally offered a means of quality assurance by confirming the diagnoses of 61 prostate carcinomas made on the basis of biopsy specimens.     

The value of immediate cytologic evaluation for needle aspiration lung biopsy

RATIONALE AND OBJECTIVES: The authors evaluate the role of immediate cytologic evaluation (ICE) with fine-needle aspiration biopsy (FNAB) for lung lesions at highest risk for pneumothorax. METHODS: A prospective randomized study was conducted of 80 patients with lung lesions surrounded by aerated parenchyma undergoing FNAB with and without ICE (47 and 33 patients, respectively). An analysis of needle passes, procedure time, complications, specimen adequacy, diagnostic yield, and accuracy of procedure was made. RESULTS: There was an increased number of needle passes with ICE (> or = three passes: 23% [11 biopsies] versus 3% [1 biopsy]; P = 0.01). Fluoroscopic procedures took longer with ICE (median time: 15 versus 9 minutes; P = 0.002) with no difference in complication rates. Specimen adequacy was similar (74% and 64%) and the procedure was diagnostic in 79% (37 biopsies) with ICE and in 70% (33 biopsies) without ICE. There were no significant differences in the sensitivity, specificity, or accuracy of the biopsy. CONCLUSIONS: Immediate cytologic evaluation improved results marginally with increased procedure time and needle passes. Immediate cytologic evaluation may be most useful for lesions at lowest risk of complications to assure that a second procedure is not required.     

Pharmacokinetics of terbinafine and five known metabolites in children, after oral administration

BACKGROUND: Deferiprone is an orally active iron-chelating agent that is being evaluated as a treatment for iron overload in thalassemia major. Studies in an animal model showed that prolonged treatment is associated with a decline in the effectiveness of deferiprone and exacerbation of hepatic fibrosis. METHODS: Hepatic iron stores were determined yearly by chemical analysis of liver-biopsy specimens, magnetic susceptometry, or both. Three hepatopathologists who were unaware of the patients' clinical status, the time at which the specimens were obtained, and the iron content of the specimens examined 72 biopsy specimens from 19 patients treated with deferiprone for more than one year. For comparison, 48 liver-biopsy specimens obtained from 20 patients treated with parenteral deferoxamine for more than one year were similarly reviewed. RESULTS: Of the 19 patients treated with deferiprone, 18 had received the drug continuously for a mean (+/-SE) of 4.6+/-0.3 years. At the final analysis, 7 of the 18 had hepatic iron concentrations of at least 80 micromol per gram of liver, wet weight (the value above which there is an increased risk of cardiac disease and early death in patients with thalassemia major). Of 19 patients in whom multiple biopsies were performed over a period of more than one year, 14 could be evaluated for progression of hepatic fibrosis; of the 20 deferoxamine-treated patients, 12 could be evaluated for progression. Five deferiprone-treated patients had progression of fibrosis, as compared with none of those given deferoxamine (P=0.04). By the life-table method, we estimated that the median time to progression of fibrosis was 3.2 years in deferiprone-treated patients. After adjustment for the initial hepatic iron concentration, the estimated odds of progression of fibrosis increased by a factor of 5.8 (95 percent confidence interval, 1.1 to 29.6) with each additional year of deferiprone treatment. CONCLUSIONS: Deferiprone does not adequately control body iron burden in patients with thalassemia and may worsen hepatic fibrosis.     

Bleeding due to needle biopsy: effect of venopirin in an animal model and implications for humans

PURPOSE: This study was undertaken to address the effect of platelet dysfunction on bleeding associated with percutaneous needle biopsy. MATERIALS AND METHODS: With use of an established animal model, 199 biopsies were performed on the livers of 13 anesthetized pigs (95 on control animals, 104 on venopirin-treated animals). The needles used were 16-22-gauge Chiba type, 18-gauge Tru-Cut, and 18-gauge Menghini. The biopsies were performed under direct vision at laparotomy with consistent technique. Blood loss was measured, and the results were compared. Statistical analysis was performed with the Student t test and the Turkey test, after logarithmic transformation of the data. RESULTS: A substantial increase in blood loss resulting from the biopsy procedures was demonstrated in the animals with platelet dysfunction. This was much greater than the effect of either needle size or prothrombin time prolongation previously reported by the authors. CONCLUSION: Platelet function may be an important factor in determining the risk of bleeding due to percutaneous needle biopsy.     

Percutaneous renal biopsy in children: a 27-year experience

BACKGROUND: The introduction of automated biopsy devices and the localization of the kidney by ultrasound were aimed at optimizing efficacy and safety of the percutaneous renal biopsy procedure. We evaluated these technological advances in our renal biopsies performed in children. METHODS: We sequentially used the Silverman needle (1969-1974), the TruCut needle (1974-1990), and the automated Biopty device (1990-1996). Fluoroscopy was used to localize the kidney until 1985, ultrasound examination prior to biopsy from 1985 to 1992, and direct ultrasound guidance since 1992. A total of 962 native kidney biopsies and 119 allograft biopsies were performed. RESULTS: In the native kidney biopsies, the introduction of the Biopty device and ultrasound guidance were independently associated with fewer passes required to obtain adequate tissue and more glomeruli per specimen. The rate of biopsies yielding more than 9 glomeruli increased from 69 to 92% (p < 0.05). The number of glomeruli harvested per centimeter core length was inversely related to patient age (p < 0.01). More appropriate cortical tissue was retrieved in renal allograft biopsy specimens with the application of the new techniques. The occurrence of macroscopic hematuria (9. 6%) in the native kidney biopsies was not affected by the puncture or localization technique applied, but subcapsular hematomas were documented more often with the Biopty device (42%) than with the TruCut needle (16%), probably due to improved ultrasound equipment. In the whole series 2 patients died, and 3 others required renal surgery and 4 blood transfusions. CONCLUSIONS: The automated ultrasound-guided procedure is a feasible and reliable technique for percutaneous renal biopsy in children. It gives a greater yield of diagnostic tissue without increasing the rate of clinical complications.     

Laparoscopy-guided biopsy in diagnosis of liver disorders in children

To determine the safety and advantages of laparoscopic liver biopsy in pediatric liver disorders, we reviewed the medical records of 80 children affected by liver disease of various etiologies who underwent this procedure from 1986 to 1996. The main indicators for laparoscopic biopsy were increased risk of bleeding (i.e., mild to moderate coagulation abnormalities in patients probably affected by cirrhosis) and/or previous poorly informative blind needle liver biopsy (65 cases), and the need for a large amount of liver tissue for biochemical assays (10 cases). After inspection of the liver surface, at least two core biopsies were performed using a Tru-cut needle. We encountered difficulties with the biopsy in only four cases, due to a hard consistency of the liver. Bleeding time from the liver orifice was greatly reduced by positioning a fibrin plug (50-120 s vs 5-10 s, on average). In 15 patients, a large excisional biopsy was also successfully performed. Our results confirm an important role for laparoscopy in the diagnosis of cirrhosis (30% of bioptic false negative diagnoses in this series) and show that in selected cases laparoscopy-guided needle or excisional biopsy is an easy, useful and safe alternative to percutaneous blind liver biopsy.     

Quantitative digital evaluation of myocardial exercise thallium-201 single-photon emission tomography in post-menopausal women

OBJECTIVE: To determine the respective roles of septal fibrosis, necroinflammatory activity, iron deposition, steatosis, and patterns of nodular and septal remodeling in the collagenization of the perisinusoidal space in livers from patients undergoing transplantation for alcoholic or posthepatitis C cirrhosis and to ascertain whether perisinusoidal collagenization has clinical implications added to those of septal fibrosis. STUDY DESIGN: Sixty-six hepatectomy specimens from patients undergoing liver transplantation for cirrhosis were analyzed. Thirty-two alcoholic and 34 posthepatitis C cirrhoses were included. Picro Sirius-stained slides were examined with polarized light and the amount of perisinusoidal collagenization measured by computerized image analysis. Size distributions of septa and nodules were assessed by mathematical morphology methods. RESULTS: The septal and perisinusoidal fibrosis indices and Knodell and Pugh-Child scores showed significant differences between alcoholic and posthepatitis cirrhoses. Correlation between septal fibrosis and perisinusoidal collagenization was weak, though significant. Both variables correlated significantly with the clinical score. The correlation was negative between septal fibrosis or perisinusoidal collagenization and the Knodell score. CONCLUSION: Perisinusoidal collagenization was not a feature of all cases of cirrhosis, although it was more prominent in alcoholics. For the whole series, it significantly correlated with the clinical score, which increased significantly when high perisinusoidal collagenization was added to high septal fibrosis. No absolute dependence was found between perisinusoidal collagenization and septal fibrosis; percentage of slender fibrous septa and amount of iron deposition were other factors entered in the regression equation.     

Focal neuroendocrine differentiation lacks prognostic significance in prostate core needle biopsies

PURPOSE: The biological behavior of prostate cancer is highly variable and cannot sufficiently be predicted by histological criteria alone. New prognostic factors are needed in core needle biopsies before initial treatment decisions. We investigate the prognostic significance of focal neuroendocrine differentiation in core needle biopsies of prostate cancer. MATERIALS AND METHODS: Core needle biopsies from 105 untreated patients (mean age 71 years) were immunohistochemically examined for focal neuroendocrine differentiation using an antibody against chromogranin A. Tumor cell proliferation was assessed with Ki-67 labeling index using MIB 1 antibody. The cause of death was determined by examination of records including autopsy reports. RESULTS: Focal neuroendocrine differentiation was found in 25% of the tumors. There was no association between the presence of focal neuroendocrine differentiation and Gleason score or Ki-67 labeling index. Tumor specific survival analysis revealed that high Gleason score and high Ki-67 labeling index were predictors of tumor specific death, whereas focal neuroendocrine differentiation failed to provide prognostic information. There was a significant increase in frequency and density of neuroendocrine differentiation between initial core needle biopsies and later specimens of secondary hormone resistant prostate cancer in 15 patients. CONCLUSIONS: In contrast to high Gleason score and high Ki-67 labeling index, focal neuroendocrine differentiation is not a prognostic factor in core needle biopsies of prostate cancer. Focal neuroendocrine differentiation seems to appear more frequently and intensively in hormone resistant prostate cancer, supporting a role of neuroendocrine cells in the development of hormone refractory disease.     

Percutaneous biopsy of small hepatic lesions using an 18 gauge automated needle

This study evaluates the efficacy of ultrasound guided percutaneous biopsy using an 18 gauge automated side-cutting needle in the diagnosis of small (< or = 3 cm) focal hepatic lesions. 137 consecutive percutaneous biopsies of 131 different small (< or = 3 cm) focal hepatic lesions were included. 11 biopsies were performed on lesions of < or = 1 cm in diameter, 56 were on lesions 1.1-2 cm in size and 70 on lesions 2.1-3 cm in size (average 2.3 +/- 0.7 cm; median 2.3 cm; range 0.7-3 cm). The biopsy specimen was sufficient for diagnosis in 135 cases (98.5%). The sensitivity for diagnosing malignancy was 96.4%; specificity was 100%, positive and negative predictive values were 100% and 94.6%, respectively; accuracy was 97.8%. There was no statistically significant difference in the diagnostic efficacy for lesions of different pathology and size. No significant post-biopsy complication occurred. It is concluded that the 18 gauge Temno needle is safe and effective in diagnosing small hepatic lesions.     

Methodological findings and considerations in measuring colorectal epithelial cell proliferation in humans

The methodological issues for measuring colorectal epithelial cell proliferation, an intermediate end point for studies of colon neoplasia, in epidemiological studies are deceptively numerous and complex, with few methodological data available. Accordingly, during our experience with measuring colorectal epithelial cell proliferation from nearly 500 participants attending over 1300 study visits over a 6-year period, we recorded data on a variety of measurement variations. Methods investigated included rectal biopsy technique, general histological and labeling procedures [including the tritiated thymidine, 5-bromodeoxyuridine (BrdUrd), and the proliferating cell nuclear antigen (PCNA) immunohistochemical techniques used to label S-phase cells in colonic crypts in rectal biopsy specimens], biopsy scoring procedures, and summary scoring methods. Findings include that the PCNA technique was the simplest, most economical, and least time-consuming. The BrdUrd labeling failure rate was 15% versus < 1% for PCNA. The percentage of labeled cells (labeling index) was highest using PCNA in biopsies processed without prior incubation, intermediate using PCNA in biopsies processed with prior incubation as for BrdUrd, and lowest using BrdUrd. The percentage of labeled cells that were in the upper 40% of the crypt (phi h) was higher using BrdUrd than PCNA; visit-to-visit correlations were higher using PCNA (r = 0.51 versus 0.35), and visit-to-visit variability was lower and between-person variability was higher using PCNA. Intra- and inter-rater reliabilities for the techniques were comparable (PCNA intra-rater r = 0.93, inter-rater r = 0.92). The PCNA technique, compared to the BrdUrd technique, is more feasible and reliable, provides a more accurate estimate of the labeling index, and cell proliferation measures determined with PCNA have statistical properties that are generally more favorable for detecting differences in clinical trials. Thus, the PCNA technique may be preferable to techniques requiring incubation of biopsies. Other methodological findings lead us to recommend that, for larger studies measuring colorectal epithelial cell proliferation on outpatient rectal biopsies, biopsies should be taken 10 cm above the anus using a flexible, preferably jumbo cup, endoscopic forceps through a rigid sigmoidoscope, and histological sections should be 3 microns thick taken 50 microns apart.     

Morphometric studies on the rat liver in biliary obstruction

The common bile ducts of the Wistar rats were ligated and severed, and liver biopsies were done weekly for 7 postoperative weeks. Light and electron microscopic specimens were prepared for the morphometric studies. The volume ratio of the hepatic parenchyma decline with the lapse of time after bile duct ligation. However, elevated mean sectional area of the nucleus, increased mitotic index and unchanged estimated weight of the hepatic parenchyma after biliary obstruction suggested that lost hepatocytes were compensated by regeneration. Mitochondrial swelling and curling of the cristae were noted in biliary obstruction in general. Moreover, both the number and volume ratio of the mitochondria were increased corresponding to the duration of biliary obstruction. These changes were interpreted as an adaptation process to mitochondrial dysfunction.     

Surgical significance of telomerase activity in noncancerous liver tissue from patients with hepatocellular carcinoma

Telomerase activity has been detected in tissue from noncancerous liver of patients with chronic liver disease, but its functional significance remains to be elucidated. We therefore evaluated the telomerase activity in surgically obtained noncancerous liver tissue from 20 hepatocellular carcinoma (HCC) patients. Two samples of noncancerous liver tissue were obtained from each patient: one from the parenchyma adjacent to the HCC nodules of the resected specimen; the other from the parenchyma distant from the HCC nodules of the remnant liver. Telomerase activity was assayed by a non-radioisotope quantitative system based on "TRAP-eze." Five samples from the noncancerous liver tissue adjacent to the HCC nodules (25.0%) were telomerase-positive; all such cases showed high-grade malignant potential, such as intrahepatic metastasis and/or portal vascular invasion and infiltration of the fibrous capsule in the corresponding HCC nodules, and telomerase positivity showed neither a relationship with the histological activity index scores nor a correlation with liver function. Interestingly, no telomerase activity was detected in any of the 20 samples obtained from the parenchyma of the remnant liver. These results indicate that telomerase in noncancerous liver tissue is associated not with the hepatic condition accompanying HCC, but with the biological characteristics of the tumor itself, and may derive from infiltrating cancer cells. Determination of telomerase status may aid in designing more effective surgical procedures.     

Psychiatric disorder and metabolic control among youths with IDDM. A longitudinal study

PURPOSE: To analyze the influence of liver dysfunction and parenchymal pathology on the accumulation of superparamagnetic iron oxide (SPIO). METHODS: We evaluated MR images of 13 patients having small hepatic neoplasms before and after administration of SPIO (10 micronol/kg). Biopsy and laboratory data confirmed the presence of severe cirrhosis in two patients, mild cirrhosis in four, chronic hepatitis in five, and normal livers in two. Degrees of liver dysfunction or liver parenchymal pathology were correlated with reductions in signal intensity of the liver and spleen after administration of SPIO. Signal intensity reduction was evaluated using a 1.5 Tesla MR unit. RESULTS: Response to SPIO of the liver and spleen did not correlate with liver parenchymal pathology, although reductions in signal intensity of the liver were somewhat small in severely cirrhotic livers. There were slight correlations between signal intensity alterations of the liver and laboratory data such as the indocyanine green retention rate (correlation coefficient 0. 47), albumin (0.36), total bilirubin (0.36), and serum glutamic oxaloacetic transaminase (GOT) (0.46). Signal intensity reduction of spleen did not correlate with liver function tests except for serum GOT. In patients with cirrhosis, heterogeneous structures were detected in the nontumorous portions of the liver. However, these did not prevent the diagnosis of small hepatomas. CONCLUSION: The uptake of SPIO showed some correlation with liver function but not with chronic liver parenchymal pathology. SPIO provided sufficient contrast between tumor and surrounding liver parenchyma among patients with chronic liver disease.     

Abnormalities of Doppler waveform of the hepatic veins in patients with chronic liver disease: correlation with histologic findings

OBJECTIVE: Changes in the Doppler waveform of the hepatic veins are associated with chronic liver disease, particularly cirrhosis. We correlated abnormalities in Doppler waveforms of hepatic veins with histologic findings in the liver to determine the accuracy of Doppler imaging in the detection of cirrhosis. SUBJECTS AND METHODS: Fifty-two patients with chronic hepatitis C were examined prospectively and blindly by two sonographers. In the same session, a liver biopsy specimen was obtained from each patient and submitted to three independent pathologists for conventional interpretation and for grading of severity according to a predetermined scoring system. Duplex sonography of the hepatic veins was also performed in 50 control subjects. RESULTS: Abnormal hepatic vein waveforms were detected in 12 of 16 patients with cirrhosis and in eight of 36 patients without cirrhosis. However, histologic examination of the biopsy specimens showed that only two of the eight patients without cirrhosis had no significant abnormalities, other than mild portal inflammation. Abnormal waveforms were seen in no control subjects. We found a correlation between fibrosis and steatosis and abnormalities in the Doppler waveform of the hepatic veins (r = .50, p < .001). Portal inflammation, intralobular degeneration, and necrosis did not correlate with an abnormal waveform. CONCLUSION: Duplex sonography of the hepatic veins may be useful for studying liver disease associated with fibrosis and steatosis. In patients with well-compensated liver disease, flattening of the Doppler waveform of the hepatic vein suggests the presence of cirrhosis.     

The applicability and diagnostic effectiveness of transjugular liver biopsy

BACKGROUND: The aim of this study was to evaluate the applicability, the diagnostic profitability and the incidence of complications associated with tranjugular liver biopsy associated with the measurement of the hepatic venous pressure gradient (HVPG). PATIENTS AND METHODS: The clinical histories of 829 consecutive patients in whom transjugular liver biopsy was performed from 1982 to 1993 were reviewed. The diagnostic value of the sample obtained was evaluated in all the patients and the HVPG determined. Moreover, the size of the greatest fragment obtained during biopsy was also determined. RESULTS: Material for histologic study was obtained in 95% of the cases. In 70% the biopsy was diagnostic, in 11% it provided data contributing to diagnosis and in 19% it was not useful. Potentially severe complications were presented in 0.8% of cases being fatal in one (0.1%). The obtention of a fragment of small size was significantly associated with the presence of disease with marked fibrosis and high HVPG. A HVPG > 10 mmHg in patients with a suspicion of liver disease had a sensibility of 92% and a specificity of 63% for the diagnosis of hepatic cirrhosis. In 83% of patients with a GPVH > 10 mmHg in whom the biopsy was not useful, the diagnosis of hepatic cirrhosis was performed by other methods. CONCLUSIONS: Transjugular biopsy in a safe, effective diagnostic method in patients with severe coagulation disorders. The appearance of the material obtained and the HVPG provide useful information for diagnosis although the biopsy is not diagnostic.     

Correlation between the clinical and pathohistologic diagnosis in "small biopsies" of the lung

INTRODUCTION: During the last 20 years routine application of various methods of multiple "small biopsies" of the lungs such as forceps, transbronchial, trucut percutaneous and so on, has significantly increased the efficacy of diagnostics of bronchopulmonary and pleural diseases. Tissue samples, not bigger than 3-4 mm, in which diagnostic pathological changes are expected on the basis of previous clinical, radiological and bronchoscopic examinations, can be the basis for making a definite therapeutical decision only if a skillful surgeon has performed the biopsy by correct instruments and from the right place and sent it for histological analysis with other important clinical information. This study is a comment on quality, significance and possibilities of improving clinical-pathological cooperation in this field of clinical pathology. MATERIAL AND METHODS: By correlation of clinical and histological diagnoses we analyzed the diagnostic efficiency of microscopic examinations of "small biopsies" of the respiratory tract in 319 patients (175 bronchial forceps biopsies, 31 transbronchial biopsies, 22 percutaneous needle pleural biopsies and 91 combined forceps and transbronchial biopsies) in whom biopsies were performed during 1996 in the Specialized Hospital for Lung Diseases Brezovik. RESULTS: Overall concordance between the clinical and histopathological diagnosis was 82.2%. In 99 cases (73.3%) out of 135 clinically "obvious" neoplasms, the histopathological examination confirmed existence of malignant tumor: squamous cell carcinoma in 80%, small cell carcinoma in 9.6% and adenocarcinoma in 5.6% of patients. In other patients it was not possible to perform a more precise classification. Endoscopic specimens of 29 patients (9.1%) were not representative. CONCLUSION: The level of diagnostic efficiency (73.3%) of definitive histopathological verification of bronchopulmonary lesions, which have been clinically diagnosed as malignancies, is rather high, but the increase of diagnostic efficiency requires application of more sophisticated histological diagnostic methods (immunohistochemical) and more frequent utilization of bioptic procedures which are more convenient for detection of peripheral pulmonary lesions (transbronchial and percutaneous fine needle aspiration biopsies of the lungs).