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Sonographic needle guidance significantly improves the performance and outcomes of outpatient IA injections in a clinically significant manner.

SUMMARY Magnetic resonance (MR) imaging and computed tomography (CT) are useful for the evaluation of central nervous system (CNS) lupus. This report describes the use of cranial MR and CT in 21 patients with systemic lupus erythematosus (SLE) with acute neuropsychiatric symptoms manifested by headache, seizures, focal neurological deficits, psychosis, or organic brain syndrome. Computed tomography was found to be insensitive and detected only diffuse atrophy (two cases), cerebral infarct (one case), and intracerebral haemorrhage (one case) in the 21 patients. Cranial MR images obtained with a General Electric 1-5 tesla Signa unit detected labile and fixed areas of increased proton intensity interpreted as focal oedema (eight cases), infarct (10 cases), haemorrhage (one), atrophy (seven), and acute sinusitis (two). Focal oedema was characterised by labile, high intensity lesions in the gray or white matter of the cerebellum, cerebrum, or brain stem, which completely resolved after aggressive corticosteroid treatment. Most high intensity reversible or fixed lesions evident on MR were not apparent on cranial CT images. In several patients sequential MR images were valuable in monitoring the efforts of treatment. Although histological confirmation of the high intensity brain lesions apparent on MR is desirable, prior necropsy studies suggest that pathological confirmation may be difficult owing to the paucity of recognisable brain lesions in patients with CNS lupus. It is concluded that for the evaluation of acute neuropsychiatric SLE MR is useful and provides more information than cranial CT.Acute neuropsychiatric lupus is associated with headache, depression, organic brain syndrome, seizures, psychosis, paresis, and a host of other neurological and psychiatric symptoms.' Because of the non-specific nature of these complaints, systemic lupus erythematosus (SLE) with central nervous system (CNS) symptoms presents a peculiar dilemma to the clinician. Confounding disorders, particularly bacterial meningitis, non-steroidal induced aseptic meningitis, brain abscess, steroid psychosis, and

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Purpose Syringes are used for diagnostic fluid aspiration and fine needle aspiration biopsy (FNA) in interventional procedures. We determined the benefits, disadvantages, and patient safety implications of syringe and needle size on vacuum generation, hand force requirements, biopsy/fluid yield, and needle control during aspiration procedures. Materials and Methods Different sizes (1, 3, 5, 10, and 20 ml) of the conventional syringe and aspirating mechanical safety syringe, the reciprocating procedure device (RPD), were studied. 20 operators performed aspiration procedures with the following outcomes measured: 1) vacuum (Torr), 2) time to vacuum (seconds), 3) hand force to generate vacuum (Torr-cm2), 4) operator difficulty during aspiration, 5) biopsy yield (mg), and 6) operator control of the needle tip position (mm). Results Vacuum increased tissue biopsy yield at all needle diameters (p < 0.002). 20 ml syringes achieved a vacuum of −517 Torr, but required significantly more strength to aspirate, and resulted in significant loss of needle control (p<0.002). The 10 ml syringe generated only 15% less vacuum (−435 Torr) than the 20 ml, and required much less hand strength. The mechanical syringe generated identical vacuum at all syringe sizes with less hand force (p<0.002), and provided significantly enhanced needle control (p<0.002). Conclusions To optimize patient safety and control of the needle and maximize fluid and tissue yield during aspiration procedures, a two-handed technique and the smallest syringe size adequate for the procedure should be used. If precise needle control or one-handed operation is required, a mechanical safety syringe should be considered.

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