Pre-Surgical Methylene-Blue “targeting” of Small Intrapulmonary Nodules In Patients with Haematological Malignancies: Preliminary Experience.

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 4551-4551
Author(s):  
M. Mansour Ceesay ◽  
Ouni Jaffer ◽  
Phillip FC Lung ◽  
Michael T Marrinan ◽  
Ranjit Deshpande ◽  
...  
Keyword(s):  
Methylene Blue ◽  
Platelet Count ◽  
Chronic Gvhd ◽  
Pulmonary Nodules ◽  
Target Lesion ◽  
Mycobacterium Fortuitum ◽  
Haematological Malignancies ◽  
Surgical Biopsy ◽  
Iodinated Contrast ◽  
Pleural Surface

Abstract Abstract 4551 The diagnosis of intrapulmonary nodules in patients with haematological malignancies is problematic as such lesions are often small and impalpable and “non-targeted” surgical biopsy is difficult. The aim was to evaluate the utility of image-guided “targeting” of small pulmonary nodules with methylene-blue before video-assisted thoracoscopic (VATS) biopsy. Eleven patients (8M:3F) with median (range) age of 48 (27-62) years with haematological malignancies (lymphoma, n=6, AML/MDS, n=3, ALL, n=1,Castleman's disease, n=1) were referred for VATS biopsy. Equal volume of iodinated contrast) was injected in the vicinity of the target lesion and along a track (including the pleural surface and the overlying chest wall), using a 20G needle. The platelet count, diameter of targeted nodules, “perpendicular” distance from the pleural surface and complications were recorded. Patients were transferred to surgery from the CT suite. The median (range) platelet count was 256×109/L (54-453). The mean (range) diameter of targeted nodules was 12.5(5-22) mm and these were at a mean distance of 14.3±8.3mm from the pleural surface. Complications included small pneumothoracis in 4/11 (36%) patients and pain in 1/11 (9%). A definitive histopathological/microbiological diagnosis was achieved in 10/11 (91%) patients and included: organising pneumonia (n=4), respiratory bronchiolitis (n=2), Kaposi's sarcoma (n=1), mycobacterium fortuitum infection (n=1) and chronic GVHD (n=1). There were no cases of angioinvasive aspergillosis. This preliminary data suggest that pre-biopsy methylene-blue targeting of intrapulmonary lesions is a safe and promising technique for the diagnosis of indeterminate lung nodules in patients with haematological malignancy. Disclosures: Mufti: Celgene: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding, Speakers Bureau.

Percutaneous Image-Guided Biopsy of the Pancreas

2018 ◽  
Vol 02 (02) ◽  
pp. 095-100
Author(s):  
Stephen McRae
Keyword(s):  
Needle Aspiration ◽  
Target Lesion ◽  
Pathological Diagnosis ◽  
Surgical Biopsy ◽  
Cross Sectional ◽  
Image Guided ◽  
Guided Biopsy ◽  
Lower Complication ◽  
Lower Complication Rate ◽  
Mass Lesions

AbstractPercutaneous image-guided biopsy of the pancreas is a safe, effective, efficient, and minimally invasive way to obtain samples for pathological diagnosis of pancreatic mass lesions. The myriad of diseases that can involve the pancreas require different therapies. Therefore, pathological diagnosis is key. With proper imaging resources and techniques, most mass lesions of the pancreas that are visible on cross-sectional imaging can be approached safely and accurately percutaneously under either computed tomography (CT) or ultrasound guidance. These lesions may be accessed through anterior, posterior, and/or lateral approaches depending upon their proximity to the anticipated skin puncture site, and the presence or absence of intervening structures. While the ideal percutaneous route to any pancreatic target lesion is the one that has no vital structures in its path, methods and tools exist to make even the most seemingly obstructed paths to pancreatic targets navigable. Once accessed, the targets may be sampled by either fine-needle aspiration or core needle biopsy. The alternatives to percutaneous image-guided biopsy of the pancreas include open (surgical) biopsy and endoscopic ultrasound-guided (EUS) biopsy. Percutaneous image-guided biopsy poses less risk to the patient than open biopsy and has been shown to be as accurate as EUS biopsy with an even lower complication rate.

scholarly journals Isolated thrombocytopenia after allogeneic bone marrow transplantation: existence of transient and chronic thrombocytopenic syndromes

Blood ◽  
1985 ◽  
Vol 65 (2) ◽  
pp. 368-374
Author(s):  
LR First ◽  
BR Smith ◽  
J Lipton ◽  
DG Nathan ◽  
R Parkman ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Platelet Count ◽  
Bone Marrow Transplantation ◽  
Marrow Transplantation ◽  
Chronic Gvhd ◽  
Allogeneic Bone Marrow Transplantation ◽  
Temporal Association ◽  
Allogeneic Bone ◽  
Normal Numbers ◽  
Bone Marrow Biopsies

Isolated thrombocytopenia after bone marrow transplantation was investigated in 65 fully engrafted patients surviving at least 60 days posttransplant. Twenty-four patients (37%) developed this complication, which occurred most frequently in patients receiving pretransplant preparation with total body irradiation or busulfan. Two distinct thrombocytopenic syndromes were identified: (1) transient thrombocytopenia (nine patients), in which a normal platelet count (greater than 100,000/microL) was initially established by day +40 but then diminished to less than 10,000 to 45,000/microL on day +40 to +70, with subsequent resolution of the thrombocytopenia by day +90; (2) chronic thrombocytopenia (15 patients), in which a platelet count greater than 100,000/microL was not achieved at any time during the first four months posttransplant, despite the simultaneous presence of normal granulocyte and reticulocyte counts. Although the transient syndrome did not adversely affect prognosis, the chronic syndrome carried a high mortality (21% actuarial survival at 1,000 days posttransplant compared with 67% survival for all patients, P less than .01) and had a high association with both severe (grades 3 to 4) acute graft-versus-host disease (GVHD) and chronic GVHD. In three of nine patients with transient thrombocytopenia, a temporal association with trimethoprim-sulfamethoxazole administration was observed, whereas in all other patients, no drug association could be found. Bone marrow biopsies in those patients with drug-associated thrombocytopenia showed decreased numbers of megakaryocytes, whereas biopsies in the remainder of the transiently thrombocytopenic patients demonstrated adequate numbers of platelet precursors, suggesting peripheral platelet destruction or ineffective thrombopoiesis. Biopsies in the chronic thrombocytopenic patients included those with and without adequate numbers of platelet precursors, although the association with chronic GVHD was strongest in patients demonstrating normal numbers of megakaryocytes. We conclude that isolated thrombocytopenia represents a significant complication of bone marrow transplantation, particularly in patients receiving hematopoietic ablative preparatory regimens, and that it is the chronic, not the transient, thrombocytopenic syndrome that is associated with an adverse patient prognosis.

Preoperative Computed Tomography-Guided Localization for Pulmonary Nodules with Glue and Dye

2020 ◽  
Vol 68 (06) ◽  
pp. 525-532
Author(s):  
Tian Jiang ◽  
Miao Lin ◽  
Mengnan Zhao ◽  
Cheng Zhan ◽  
Ming Li ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Methylene Blue ◽  
Success Rate ◽  
Complication Rate ◽  
Lung Resection ◽  
Surgical Margin ◽  
Pulmonary Nodules ◽  
Blue Dye ◽  
Methylene Blue Dye ◽  
Ct Guided

Abstract Background This study was aimed to describe a new localization technique developed using medical glue and methylene blue dye, and characterized the localization results and postoperative outcome to evaluate its safety and usefulness. Methods This retrospective study was conducted at our center from January 2016 to April 2018. Totally 346 consecutive patients with 383 nodules who underwent preoperative computed tomography (CT)-guided medical glue and methylene blue dye localization, followed by lung resection, were enrolled in this study. Results Mean nodule size was 7.7 ± 3.7 mm (range: 2–30 mm), with a mean depth from pleura or fissure of 9.4 ± 9.3 mm (range: 0–60 mm). The success rate of CT-guided localization for pulmonary nodules was 99.5% (381/383) of the nodules. Localization-related complications included mild pneumothorax in 16 (4.6%) patients, mild hemothorax in 7 (2.0%) patients, and hemoptysis in 1 (0.3%) patient. Pleural reaction occurred in 7 (2.0%) and pain in 25 (7.2%) patients. All 383 nodules were resected successfully, with conversion to thoracotomy only required in two patients for adhesion and calcification of lymph nodes. All patients recovered well postoperatively, with a short postoperative hospital stay (3.7 ± 2.0 days) and a low complication rate (2.6%, 9/346). Conclusion CT-guided medical glue and methylene blue dye localization prior to video-assisted thoracoscopic surgery (VATS) lung resection was a novel, safe, and technically feasible method, with a high-technical success rate and a low-complication rate. It allowed surgeons to easily locate and detect the nodules and estimate the surgical margin.

Combined Hookwire and Methylene Blue Localization of Pulmonary Nodules

2018 ◽  
Vol 13 (3) ◽  
pp. 184-189 ◽  
Author(s):  
John Joseph Brady ◽  
Christie Hirsch Reilly ◽  
Robert Guay ◽  
Uday Dasika
Keyword(s):  
Methylene Blue ◽  
Pulmonary Nodules

Computed Tomography–Guided Methylene Blue Labeling Prior to Thoracoscopic Resection of Small Deeply Placed Pulmonary Nodules. Do We Really Need Palpation?

2017 ◽  
Vol 65 (05) ◽  
pp. 387-391 ◽  
Author(s):  
S. Demiröz ◽  
Selma Apaydın ◽  
Hakan Ertürk ◽  
Suzan Biri ◽  
Funda Incekara ◽  
...  
Keyword(s):  
Methylene Blue ◽  
Thoracic Surgery ◽  
Fdg Pet ◽  
Pulmonary Nodules ◽  
Blue Staining ◽  
Ct Guided ◽  
Pet Ct ◽  
18F Fdg ◽  
Fdg Pet Ct ◽  
Pet Ct Scan

Background Video-assisted thoracic surgery (VATS) is widely used for thoracic surgery operations, and day by day it becomes routine for the excision of undetermined pulmonary nodules. However, it is sometimes hard to reach millimetric nodules through a VATS incision. Therefore, some additional techniques were developed to reach such nodules little in size and which are settled on a challenging localization. In the literature, coils, hook wires, methylene blue, lipidol, and barium staining, and also ultrasound guidance were described for this aim. Herein we discuss our experience with CT-guided methylene blue labeling of small, deeply located pulmonary nodules just before VATS excision. Method From April 2013 to October 2016, 11 patients with millimetric pulmonary nodules (average 8, 7 mm) were evaluated in our clinic. For all these patients who had strong predisposing factors for malignancy, an 18F-FDG PET-CT scan was also performed. The patients whose nodules were decided to be excised were consulted the radiology clinic. The favorable patients were taken to CT room 2 hours prior to the operation, and CT-guided methylene blue staining were performed under sterile conditions. Results Mean nodule size of 11 patients was 8.7 mm (6, 2–12). Mean distance from the visceral pleural surface was 12.7 mm (4–29.3). Four of the nodules were located on the left (2 upper lobes, 2 lower lobes), and seven of them were on the right (four lower lobes, two upper lobes, one middle lobe). The maximum standardized uptake values (SUV max) on 18F-FDG PET/CT scan ranged between 0 and 2, 79. Conclusion CT-guided methylene blue staining of millimetric deeply located pulmonary nodules is a safe and feasible technique that helps surgeon find these undetermined nodules by VATS technique without any need of digital palpation.

scholarly journals Radial-probe EBUS for the diagnosis of peripheral pulmonary lesions

2016 ◽  
Vol 42 (4) ◽  
pp. 248-253 ◽  
Author(s):  
Marcia Jacomelli ◽  
Sergio Eduardo Demarzo ◽  
Paulo Francisco Guerreiro Cardoso ◽  
Addy Lidvina Mejia Palomino ◽  
Viviane Rossi Figueiredo
Keyword(s):  
Diagnostic Yield ◽  
Pulmonary Nodules ◽  
High Sensitivity ◽  
Needle Aspiration ◽  
Tertiary Hospital ◽  
Target Lesion ◽  
Transbronchial Needle Aspiration ◽  
Pulmonary Lesions ◽  
Mean Diameter ◽  
Peripheral Pulmonary Lesions

ABSTRACT Objective: Conventional bronchoscopy has a low diagnostic yield for peripheral pulmonary lesions. Radial-probe EBUS employs a rotating ultrasound transducer at the end of a probe that is passed through the working channel of the bronchoscope. Radial-probe EBUS facilitates the localization of peripheral pulmonary nodules, thus increasing the diagnostic yield. The objective of this study was to present our initial experience using radial-probe EBUS in the diagnosis of peripheral pulmonary lesions at a tertiary hospital. Methods: We conducted a retrospective analysis of 54 patients who underwent radial-probe EBUS-guided bronchoscopy for the investigation of pulmonary nodules or masses between February of 2012 and September of 2013. Radial-probe EBUS was performed with a flexible 20-MHz probe, which was passed through the working channel of the bronchoscope and advanced through the bronchus to the target lesion. For localization of the lesion and for collection procedures (bronchial brushing, transbronchial needle aspiration, and transbronchial biopsy), we used fluoroscopy. Results: Radial-probe EBUS identified 39 nodules (mean diameter, 1.9 ± 0.7 cm) and 19 masses (mean diameter, 4.1 ± 0.9 cm). The overall sensitivity of the method was 66.7% (79.5% and 25.0%, respectively, for lesions that were visible and not visible by radial-probe EBUS). Among the lesions that were visible by radial-probe EBUS, the sensitivity was 91.7% for masses and 74.1% for nodules. The complications were pneumothorax (in 3.7%) and bronchial bleeding, which was controlled bronchoscopically (in 9.3%). Conclusions: Radial-probe EBUS shows a good safety profile, a low complication rate, and high sensitivity for the diagnosis of peripheral pulmonary lesions.

scholarly journals Isolated thrombocytopenia after allogeneic bone marrow transplantation: existence of transient and chronic thrombocytopenic syndromes

Blood ◽  
1985 ◽  
Vol 65 (2) ◽  
pp. 368-374 ◽  
Author(s):  
LR First ◽  
BR Smith ◽  
J Lipton ◽  
DG Nathan ◽  
R Parkman ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Platelet Count ◽  
Bone Marrow Transplantation ◽  
Marrow Transplantation ◽  
Chronic Gvhd ◽  
Allogeneic Bone Marrow Transplantation ◽  
Temporal Association ◽  
Allogeneic Bone ◽  
Normal Numbers ◽  
Bone Marrow Biopsies

Abstract Isolated thrombocytopenia after bone marrow transplantation was investigated in 65 fully engrafted patients surviving at least 60 days posttransplant. Twenty-four patients (37%) developed this complication, which occurred most frequently in patients receiving pretransplant preparation with total body irradiation or busulfan. Two distinct thrombocytopenic syndromes were identified: (1) transient thrombocytopenia (nine patients), in which a normal platelet count (greater than 100,000/microL) was initially established by day +40 but then diminished to less than 10,000 to 45,000/microL on day +40 to +70, with subsequent resolution of the thrombocytopenia by day +90; (2) chronic thrombocytopenia (15 patients), in which a platelet count greater than 100,000/microL was not achieved at any time during the first four months posttransplant, despite the simultaneous presence of normal granulocyte and reticulocyte counts. Although the transient syndrome did not adversely affect prognosis, the chronic syndrome carried a high mortality (21% actuarial survival at 1,000 days posttransplant compared with 67% survival for all patients, P less than .01) and had a high association with both severe (grades 3 to 4) acute graft-versus-host disease (GVHD) and chronic GVHD. In three of nine patients with transient thrombocytopenia, a temporal association with trimethoprim-sulfamethoxazole administration was observed, whereas in all other patients, no drug association could be found. Bone marrow biopsies in those patients with drug-associated thrombocytopenia showed decreased numbers of megakaryocytes, whereas biopsies in the remainder of the transiently thrombocytopenic patients demonstrated adequate numbers of platelet precursors, suggesting peripheral platelet destruction or ineffective thrombopoiesis. Biopsies in the chronic thrombocytopenic patients included those with and without adequate numbers of platelet precursors, although the association with chronic GVHD was strongest in patients demonstrating normal numbers of megakaryocytes. We conclude that isolated thrombocytopenia represents a significant complication of bone marrow transplantation, particularly in patients receiving hematopoietic ablative preparatory regimens, and that it is the chronic, not the transient, thrombocytopenic syndrome that is associated with an adverse patient prognosis.

scholarly journals Graft-v-host disease is associated with autoimmune-like thrombocytopenia [see comments]

Blood ◽  
1989 ◽  
Vol 73 (4) ◽  
pp. 1054-1058 ◽  
Author(s):  
C Anasetti ◽  
W Rybka ◽  
KM Sullivan ◽  
M Banaji ◽  
SJ Slichter
Keyword(s):  
Platelet Count ◽  
Marrow Transplantation ◽  
Chronic Gvhd ◽  
Platelet Destruction ◽  
Marrow Graft ◽  
Host Disease ◽  
Antiplatelet Antibodies ◽  
Platelet Survival ◽  
Allogeneic Marrow Transplantation ◽  
Persistent Thrombocytopenia

Abstract Persistent thrombocytopenia after allogeneic marrow transplantation is associated with poor patient survival. To identify the mechanisms of the thrombocytopenia, we studied platelet and fibrinogen kinetics and antiplatelet antibodies in 20 patients between 60 and 649 days (median 90) after transplantation. Seventeen patients had isolated thrombocytopenia (less than 100 X 10(9) platelets/L): the marrow cellularity was normal in five patients and slightly reduced in 12, and there was no discrepancy between thrombopoiesis and myeloerythropoiesis. Three patients had pancytopenia following marrow graft rejection (two) and relapse of leukemia (one). Only three patients had evidence of increased platelet production, indicating that in most cases there is a poor marrow response to thrombocytopenia early after marrow grafting. There was no correlation between platelet count and splenic pooling, suggesting that hypersplenism was an unlikely mechanism of the thrombocytopenia. Although there was a direct relationship between platelet count and platelet survival, the reduction in platelet survival was greater than what could be explained by the fixed platelet removal found in thrombocytopenic patients; this suggests increased platelet destruction. Seven patients had intercurrent infections that reduced both platelet and fibrinogen survivals. In addition, platelet antibodies bound to autologous or marrow donor platelets were present in five of the 12 patients studied. Patients with antiplatelet antibodies had lower platelet counts (30 +/- 10 X 10(9)/L v. 49.1 +/- 28.7 X 10(9)/L, P less than 0.05) and platelet survivals (1.32 +/- 0.92 days v. 3.58 +/- 2.02 days, P less than 0.05) than patients without antiplatelet antibodies. Furthermore, platelet- bound autoantibodies were present in five of six patients with grade II- IV acute or chronic graft-versus-host disease (GVHD), but were not present in six patients free of GVHD (P less than 0.01). We conclude that persistent thrombocytopenia after marrow transplantation is most often secondary to increased platelet destruction mediated by multiple mechanisms and that platelet autoantibodies are found in patients with acute or chronic GVHD.

Pretransplant Parathyroid Hormone Level Has No Correlation with Platelet Recovery After Stem Cell

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 4495-4495
Author(s):  
Soo-Jeong Kim ◽  
Yundeok Kim ◽  
Shin-Young Hyun ◽  
Ji-Eun Jang ◽  
Doh Yu Hwang ◽  
...  
Keyword(s):  
Stem Cell ◽  
Platelet Count ◽  
Stem Cell Niche ◽  
Chronic Gvhd ◽  
Platelet Recovery ◽  
Allogeneic Hsct ◽  
Post Transplant ◽  
Cell Niche ◽  
Serum Pth ◽  
Pth Level

Abstract Abstract 4495 Background Stem cell fate is influenced by specialized microenvironments called as stem cell niche. Osteoblasts are considerd to play very important role in stem cell niche. They are activated by parathyroid hormone (PTH) or PTH related protein through PTH/PTHrP receptor and produce hematopoietic growth factors. In few large animal studies PTH treatment after hematopoietic stem cell transplantation (HSCT) improved post-transplant platelet count and CD4 lymphocyte count. Effect of PTH on cord blood stem cell transplantation to improve engraftment is under clinical trial. Therefore, authors investigated on correlation between pre-transplant serum PTH level and platelet recovery after allogeneic HSCT. Methods From January 2008 to December 2009, we measured pre-transplant serum PTH, ferritin of 28 patients who underwent allogeneic HSCT. Post-transplant platelet was checked at the point of post-transplant 14 days, 30 days, 60 days, 90 days and 180days. Surveillance of cytomegalovirus was done by weekly or biweekly CMV-PCR assay. Acute graft-versus-host disease (GVHD) was graded by IBMTR classification and chronic GVHD by NIH scoring system. Results Five patients received graft from partially matched donors and the others from fully matched donors, 15 from unrelated and 13 from related donors. Nineteen patients were in high risk at diagnosis. Nonmyeloablative conditioning was applied to 7 patients. Only 1 patient used bone marrow as stem cell source. Median dose of infused stem cell was 5.7×10∧6/kg (range 1.68 – 12.74). All patients were successfully engrafted. Acute GVHD more than grade 2 occurred in 15, and chronic GVHD more than moderate degree in 7. Five patients relapsed and 15 patients died of relapse or treatment related mortality. Pre-transplant serum PTH had no correlation with platelet count recovery. There was no correlation with pre-HSCT PTH and acute or chronic GVHD. However patient with lower PTH level had tendency to more frequent CMV reactivation (P=0.098). Conclusion Our hypothesis was that higher pre-transplant PTH would be related to better platelet recovery but failed to find correlation between two of them. There are various factors which affect engraftment and graft function. Role of PTH for engraftment should be evaluated in larger number of cases. Disclosures: No relevant conflicts of interest to declare.

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