The management of a neck mass is dictated by its nature, location and extent. Pathological diagnosis by fine needle aspiration cytology (FNAC) or core biopsy is often required before proceeding to definitive treatment. It is not uncommon for the cytology result to come back as inadequate for various reasons. The unique design of the end-cutting biopsy needle in our experience makes it a good choice for use in obtaining both transcutaneous and intraoral biopsy under ultrasound guidance of neck lesions and serves as a useful alternative or adjunct to FNAC. Although there is, as yet, only a limited evidence base about end-cutting in comparison to side-cutting needles, they carry several potential advantages. Key Points • End-cutting needles are safe to use for lesions close to vital structures.• End-cutting needles yield sufficient tissue samples in a single pass.• End-cutting biopsy needles are a useful adjunct to FNAC.
SummaryMild hypothermia (34-35°C) increases peri-operative blood loss. We have previously demonstrated the beneficial effect of in vitro desmopressin on impairment of primary haemostasis associated with hypothermia. This study evaluated subcutaneous desmopressin in 52 healthy volunteers, randomly assigned to receive either normal saline or desmopressin 1.5, 5 or 15 lg (with 13 in each group). Blood samples were collected before and 2 h after drug administration and incubated at 32 and 37°C. Platelet function analyser PFA-100 Ò closure times were measured. Hypothermia at 32°C prolonged mean (95% CI) closure times (for adenosine diphosphate ⁄ collagen by 11.3% (7.5-15.2%) and for adrenaline ⁄ collagen by 16.2% (11.3-21.2%); these changes were reversed by desmopressin. A very small dose was found to be effective (1.5 lg); this dose did not significantly change closure times at 37°C, but fully prevented its prolongation at 32°C. Subcutaneous desmopressin prevents the development of hypothermia-induced impairment of primary haemostasis.
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