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Celiac disease serology in patients with different pretest probabilities: Is biopsy avoidable?  [cached]
Emilia Sugai, María L Moreno, Hui J Hwang, Ana Cabanne, Adriana Crivelli, Fabio Nachman, Horacio Vázquez, Sonia Niveloni, Julio Argonz, Roberto Mazure, Graciela La Motta, María E Caniggia, Edgardo Smecuol, Néstor Chopita, Juan C Gómez, Eduardo Mauri?o, J
World Journal of Gastroenterology , 2010,
Abstract: AIM: To establish the diagnostic performance of several serological tests, individually and in combination, for diagnosing celiac disease (CD) in patients with different pretest probabilities, and to explore potential serological algorithms to reduce the necessity for biopsy.METHODS: We prospectively performed duodenal biopsy and serology in 679 adults who had either high risk (n = 161) or low risk (n = 518) for CD. Blood samples were tested using six assays (enzyme-linked immunosorbent assay) that detected antibodies to tissue transglutaminase (tTG) and deamidated gliadin peptide (DGP).RESULTS: CD prevalence was 39.1% in the high-risk population and 3.3% in the low-risk group. In high-risk patients, all individual assays had a high diagnostic efficacy [area under receiving operator characteristic curves (AU ROC): 0.968 to 0.999]. In contrast, assays had a lower diagnostic efficacy (AU ROC: 0.835 to 0.972) in the low-risk group. Using assay combinations, it would be possible to reach or rule out diagnosis of CD without biopsy in 92% of cases in both pretest populations. We observed that the new DGP/tTG Screen assay resulted in a surplus compared to more conventional assays in any clinical situation.CONCLUSION: The DGP/tTG Screen assay could be considered as the best initial test for CD. Combinations of two tests, including a DGP/tTG Screen, might be able to diagnose CD accurately in different clinical scenarios making biopsy avoidable in a high proportion of subjects.
A new method of kidney biopsy using low dose CT-guidance with coaxial trocar and bard biopsy gun  [cached]
Pi Xiao-ling,Tang Zhen,Fu Li-qian,Guo Mei-hua
Biological Procedures Online , 2013, DOI: 10.1186/1480-9222-15-1
Abstract: Background To explore a new method of kidney biopsy with coaxial trocar and bard biopsy gun under low dose computed tomography (CT)-guidance and evaluate its accuracy, safety, and efficacy. Methods Sixty patients underwent renal biopsy under CT-guidance. They were randomly divided into two groups: group I, low dose CT-guided (120 kV and 25 or 50 mAs) and group II, standard dose CT-guided (120 kV and 250 mAs). For group I, the coaxial trocar was accurately placed adjacent to the renal capsule of the lower pole, the needle core was removed, and samples were obtained with a bard biopsy gun. For group II, the coaxial trocar was not used. Total number of passes, mean biopsy diameter, mean glomeruli per specimen, mean operation time, mean scanning time, and mean radiation dose were noted. Dose-length product (DLP) was used to calculate the radiation doses. After 24 hours of the biopsy, ultrasound was repeated to identify any subcapsular hematoma. Results Success rate of biopsy in group I was 100% while using low dose CT-guidance along with coaxial trocar renal. There was no statistic differences bewteen group I and II in the total number of passes, mean biopsy diameter, mean glomeruli per specimen and mean time of operation and CT scanning. The average DLP of group I was lower as compared to the value of group II (p <0.05). Conclusions Kidney biopsy using coaxial trocar and bard biopsy gun under low dose CT was an accurate, simple and safe method for diagnosis and treatment of kidney diseases. It can be used for repeat and multiple biopsies, particularly suitable for obese and renal atrophy patients in whom the kidneys are difficult to image.
Right Hemisphere Cerebral Infarction Due to Air Embolism from Percutaneous Lung Biopsy: A Case Report  [PDF]
Chaitanya Ahuja, Yama Kharoti, Jeffery J. Critchfield, Meghna Chadha
Open Journal of Radiology (OJRad) , 2013, DOI: 10.4236/ojrad.2013.33021
Abstract:

Percutaneous transthoracic needle biopsy is a common procedure in interventional radiology. Systemic arterial air embolism causing cerebral infarction is a rare but much feared complication of percutaneous lung biopsy. We present a comprehensive review of iatrogenic air embolism post-lung biopsy, a complication that is often sub optimally managed. Patho-physiology, clinical features, and risk factors and management are reviewed.

Systemic air embolism after transthoracic lung biopsy: A case report and review of literature  [cached]
Wessam Bou-Assaly, Perry Pernicano, Ellen Hoeffner
World Journal of Radiology , 2010,
Abstract: Computed tomography (CT)-guided lung biopsy is a common diagnostic procedure that is associated with various complications, including pneumothorax, hemoptysis and parenchymal hemorrhage. Systemic air embolism is a very rare (0.07%) but potentially life-threatening complication. We report a fatal case of air embolism to the cerebral and coronary arteries confirmed by head and chest CT, followed by a review of the literature.
Left Ventricular and Coronary Air Embolism Complicating a Routine CT-Guided Cavitating Lung Mass Biopsy: A Case Report
Obi C. Iwuagwu Obi Cosmos,Erondu Okechukwu Felix
Research Journal of Medical Sciences , 2012, DOI: 10.3923/rjmsci.2010.248.251
Abstract: Air embolism is an extremely rare complication of image guided trans-thoracic percutaneous lung biopsy whatever the modality or technique employed. Air embolism in the coronary arteries is an even rarer form and is scarcely reported in British medical literature. We present a case of coronary artery embolism following percutaneous trans-thoracic lung biopsy in a 70 years old female and highlight the need for both the interventional radiologist and the referring physician to be aware of this potentially risky complication. An immediate post-biopsy CT is usually adequate to make the diagnosis and is therefore recommended for patients manifesting vaso-vagal syncope and those with a previous history of myocardial infarction.
Systemic air embolism during percutaneous core needle biopsy of the lung: frequency and risk factors
Martin C Freund, Johannes Petersen, Katharina C Goder, Tillmann Bunse, Franz Wiedermann, Bernhard Glodny
BMC Pulmonary Medicine , 2012, DOI: 10.1186/1471-2466-12-2
Abstract: In a retrospective observational study, all PCNBs of the thorax in 610 patients between 2007 and 2009 were analyzed. The SmartStep? technique (General Electric) was used for the biopsy, with which the examiner can prepare a batch of three 1.25-mm or 2.5-mm collimated slices within a second using a foot switch in the CT room to check the needle position. The image data thus generated and the control CT scans that followed were examined retrospectively for the presence of intravascular air. Intravascular air was defined as two or more adjacent voxels with absorption values of < -200 HU in the left atrium, left ventricle, aorta, or arteries during or after the procedure. The univariate statistical analysis of categorical variables was made using 2 by 2 tables and the Fisher test. The groups were compared using the Mann-Whitney test. Finally, a multivariate logistic regression analysis was used to identify independent risk factors for the occurrence of an SAE.The radiological incidence of an SAE during a PCNB was 3.8% (23/610 patients), whereas the clinically apparent incidence was 0.49%. Two patients developed clinical symptoms consisting of transient hemiplegia or transient amaurosis; one died due to a fatal SAE of the coronary arteries. The mortality was thus 0.16%. The depth of the needle in the lesion (Wald: 6.859), endotracheal anesthesia (Wald: 5.721), location of the lesion above the level of the left atrium (Wald: 5.159), and prone position of the patients (Wald: 4.317) were independent risk factors for the incidence of an SAE (p < 0.05 each). Using explorative criteria, the acute angle of the needle to the tumor surface, and the transition of ventilated lung were independent factors. The frequency of biopsies, needle penetration depth, and tumor location near the diaphragm or in the lower lobe also played a subordinate role, not however, the needle penetration depth through the lung.If possible, the PCNB should be performed under local anesthesia. We recommend
Avoidable sets in groups  [PDF]
Mike Develin
Mathematics , 2002,
Abstract: In a set equipped with a binary operation, (S,*), a subset U is defined to be avoidable if there exists a partition {A,B} of S such that no element of U is the product of two distinct elements of A or of two distinct elements of B. For more than two decades, avoidable sets in the natural numbers (under addition) have been studied by renowned mathematicians such as Erdos, and a few families of sets have been shown to be avoidable in that setting. In this paper we investigate the generalized notion of an avoidable set and determine the avoidable sets in several families of groups; previous work in this field considered only the case (S, *) = (N, +).
Avoidable mortality in the Russian regions
Sabgajda T.P.,Ivanova A.E.,Semenova V.G.,Evdoku?kina G.N.
Stanovni?tvo , 2011, DOI: 10.2298/stnv1102001s
Abstract: The current trends of avoidable mortality, which is an integral indicator of health system performance, were analyzed. The paper discusses the regional heterogeneity of levels and trends in avoidable mortality in the Russian Federation. Also, it contains the analysis of impact of the financial costs of public health on avoidable mortality in regions with different levels of economic development. The last 20-years period was studied, which includes a stage of crisis as well as a social recovery phase. The official data of the State Statistics Committee were analyzed. In Russia, all death cases are registered in accordance to the international classification ICD-10. Special computer program summarizes death cases from preventable causes, and calculates the standardized rates for the population aged from 5 to 64 years. The old European standard of population age structure is used. Estimates of avoidable mortality were made in accordance with the European approach, under which avoidable mortality accumulates deaths of persons aged from 5 to 64 years due to 34 causes and 4 classes of causes. These 38 causes are divided into 3 groups according to three levels of diseases prevention. The level of avoidable mortality in the different regions varies up to 8 times. That is comparable to the difference between Russia and the countries of European Union in 1994. This gap is due to the coexistence of different stages of epidemiological development among the regions in Russia. When death rates increased, it is shown that mortality from causes which are preventable by measures of primary and tertiary prevention increased to a greater extent than mortality from the causes which depend from measures of secondary prevention. Therein, the largest growth of observed mortality was due to low quality of medical care in case of males (group 3), and due to causes which are preventable by measures of primary prevention in case of females (group 1). When mortality was reduced, the rates of change for causes in groups 1 and 3 were approximately the same for both sexes. Avoidable mortality due to late detection of malignant tumors (group 2) has been changed the least. Preventable component defines over 80% of the regional differences in death rates. In 2009, the level of avoidable mortality differed more than fourfold among different regions of the Russia. Similarly, the difference in the level of unavoidable mortality was 1.3-fold and 1.7-fold, for males and females respectively. Proportion of deaths from preventable causes in the total sum of death cases varies from 40% till 75%
Avoidable Sets in The Bicyclic Inverse Semigroup  [PDF]
Nandor Sieben
Mathematics , 2007,
Abstract: A subset $U$ of a set $S$ with a binary operation is called {\it avoidable} if $S$ can be partitioned into two subsets $A$ and $B$ such that no element of $U$ can be written as a product of two distinct elements of $A$ or as the product of two distinct elements of $B$. The avoidable sets of the bicyclic inverse semigroup are classified.
Rapid assessment of avoidable blindness
Hannah Kuper,Sarah Polack,Hans Limburgh
Community Eye Health Journal , 2006,
Abstract: The planning of eye care programmes requires data on the prevalence and causes of blindness. Unfortunately, programme planning is often hampered by the lack of data, because no surveys have been conducted in the area or the surveys are too old to be relevant. Programme planners are often reluctant to plan surveys, as they are believed to be expensive, time-consuming, and complicated. The Rapid Assessment of Avoidable Blindness (RAAB) has been developed as a simple and rapid survey methodology that can provide data on the prevalence and causes of blindness. So far, RAAB has been successfully undertaken in Kenya,1 Bangladesh,2 the Philippines, Botswana, Rwanda, Mexico, and China (personal communication). RAAB is an updated and modified version of the Rapid Assessment of Cataract Surgical Services (RACSS).
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