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Aspiration pneumonia occurs most frequent in patients that are in a coma or in those who are so seriously ill that they barely breathe. It affects more frequent the elders but it can also occur at other age categories.

Aspiration pneumonia refers to the problem of mouth contents entering the airways instead of going into the stomach. This can lead to an infection of the lungs, fever and breathing problems, even a bacterial pneumonia.

Generally, a person who has a malfunctioning swallowing mechanism, who does not posses a good cough reflex, could develop aspiration pneumonia. Even those patients who are fed with a tube that goes directly into their stomach could develop this problem, due to a regurgitation of the stomach contents into the throat and then into the lungs.

It is highly indicated for such persons to eat in an upright position, and stay in this position for 30 minutes after eating is done. Even the patient’s own saliva may get into the lungs, especially if he has an increased production of saliva. To prevent this, cleaning the mouth with a dry bandage and frequent suctioning of the mouth is highly recommended.

Patients who still have tracheotomy should clean the tracheotomy tube of the coughed material, this way preventing mucus and bacteria from being aspirated back into the lungs and causing a bacterial pneumonia which is a serious illness.

There are some methods of keeping the lungs expanded, and so, helping to loosen up the material that needs to be taken out: clapping or cupping the chest, breathing exercises, changing the body’s position more frequent, and using a vibrator over the chest.

Aspiration pneumonia can even lead to one’s death by chocking with the sucked materials; this is why prevention is so important.

When a lung infection occurs treating it at the right moment and with the right drugs could lead to its cure and save the patient from developing other complications like producing a partial collapse (atelectasis) of the lung.

Signs of installed complications like bacterial pneumonia are: cough with yellow or greenish sputum, high grade fever, chest pains, breathing problems, muscle aches and fatigue. Treatment consists in administering antibiotic drugs, controlling the fever, and most of all, preventing lung aspiration of mouth materials from occurring again.

The treatment of aspiration pneumonia consists in administering oxygen, aspiration of the foreign materials from the airways, and total spell. The therapy will include anti-shock medication and antibiotics.

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Aspiration pneumonia refers to inflammation of the lungs due to inhalation of foreign matters (food, saliva, nasal secretions). Virtually any fluids or solid irritants (dust particles) that frequently enter the airways can lead to the occurrence of aspiration pneumonia. Aspiration pneumonia can generate moderate or high fever due to inflammation of the lower respiratory tract’s soft tissues, membranes and organs involved in the process of breathing. Unattended, this type of pneumonia can result in partial lung failure (atelectasis). Although aspiration pneumonia is not an infectious disease, in time it can lead to serious pulmonary bacterial infections. On the premises of lung inflammation and weakened defenses of the respiratory system (cilia barriers, mucus), aspiration pneumonia facilitates the occurrence of severe bacterial pneumonia. Furthermore, aspiration pneumonia can even lead to death by asphyxiation (due to obstruction of breathing).

The categories of people exposed to the highest risk of developing aspiration pneumonia are: people who can’t swallow properly or have a poor cough reflex (infants, very young children, the elderly) and people with serious disabilities that involve bed confinement. Aspiration pneumonia is very common in comatose patients and people who suffer from paralysis, as immobility and prolonged horizontal position of the body render them very susceptible to inhalation of their own mouth and nasal secretions. Also, prolonged bed confinement can lead to regurgitation of the stomach content inside the throat and mouth, allowing stomach fluids to reach the upper levels of the respiratory tract, from where they may be inhaled into the lungs. Despite the fact that comatose patients are usually fed via tubes that enter directly inside the stomach, they are still exposed to a high risk of aspiration pneumonia as a result of stomach fluids reflux into the throat and mouth.

The occurrence of aspiration pneumonia in disabled or comatose patients can be easily prevented by slightly elevating patients’ head and torso during feedings. Patients should be maintained in this position for at least 30 minutes after feeding. This procedure is recommended for patients who receive tube feedings as well. Patients who suffer from an overproduction of saliva also require special medical care. In order to prevent the inhalation of excess saliva, this category of patients should be kept under permanent medical monitoring. Constant mouth suctioning and frequent wiping of the mouth and nose can prevent the occurrence of aspiration pneumonia in such patients. Constant changing of position can also minimize the risk of aspiration pneumonia in disabled and comatose patients.

Patients who present signs of fluid inhalation need immediate medical assistance. Tube suctioning of the airways is an effective means of clearing patients’ respiratory tract from inhaled foreign matters. Chest massage and application of pressure on patients’ chest can stimulate cough reflexes, thus allowing the elimination of inhaled matters.

Although aspiration pneumonia is highly preventable and treatable (if timely discovered), it still accounts for many deaths among patients with special conditions. People with poor freedom of movement and immobile people need permanent surveillance in order to prevent the occurrence of aspiration pneumonia.

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Three methods are currently used the assess thyroid nodules. These are fine needle aspiration or FNA, thyroid scans, and ultrasound. Of these three, initial FNA is said to be more diagnostically useful and cost effective. Although ultrasound may be able to detect nodules that cannot be detected through palpation, it is still unable to differentiate between a malignant and benign nodule. Thyroid scans, too, can be misleading in interpreting the malignancy of thyroid nodules.

Fine needle aspiration biopsy is a technique wherein a sample of the tissue is aspirated using a fine needle to be assessed. For superficial tissue as in the thyroid, breast, or prostate, the needle is unguided but for deeper tissue, the needle must be guided radiologically.

The Normal Thyroid under the Microscope

Unlike other endocrine glands, the thyroid gland is unique in that it provides extracellular storage for its products inside cyst-like follicles. These follicles contain thyroid hormones good enough for several weeks. They are nearly spherical in shape and surrounded by a single layer of cuboidal cells. These follicles range from 0.2 to 0.9 mm in diameter and are filled with a substance referred to as colloid.

Some cytophathologists believe that there must be at least six clusters of follicular cells of 10 to 20 cells each on two slides for a thyroid biopsy to qualify as benign. A diagnosis of malignancy can be made when there are fewer cells, provided that there are other signs of malignancy present in the specimen.

Cytopathologic Characteristics

Thyroid fine needle aspiration can be difficult and challenging as the amount of tissue on the slides for examination may depend on the method of aspiration. However, the evaluation of thyroid tissue should include the following:

• The presence or absence of follicles
• Cell size
• Staining characteristics of the cells
• Tissue polarity. This should be considered in cell block specimens only.
• Presence of nuclear grooves and/or nuclear clearing
• Presence of nucleoli
• Presence and type of colloid
• Monotonous population of either follicular or Hurthle cells
• Presence of lymphocytes

Benign Lesions

Almost seventy percent of cases of thyroid masses are benign lesions. Although the clinical signs in a patient may favor benign lesions, FNA it does not really mean that FNA should be excluded in the workup. These are the following clinical characteristics of benign thyroid lesions:

• A sudden onset of pain and tenderness may suggest hemorrhage into a benign adenoma or cyst, or subacute granulomatous thyroiditis, respectively. However, hemorrhage into a cancer may present with similar signs.
• Symptoms suggesting hyperthyroidism or autoimmune thyroiditis (Hashimoto’s disease).
• Family history of benign nodular disease, Hashimoto’s disease, or autoimmune thyroiditis.
• A smooth, soft, and easily movable nodule.
• Multi-nodularity.
• A midline nodule over the hyoid bone that moves up and down with the protrusion of the tongue is most likely a thyroglossal duct cyst.

Cytological and laboratory characteristics of a benign thyroid nodule are the following:

• The presence of abundant watery colloid.
• Foamy macrophages.
• Cyst or cyst degeneration of a solid nodule.
• Hyperplastic nodule.
• Abnormal TSH levels.
• Lymphocytes and/or high thyroid peroxidase antibody levels. These may suggest Hashimoto’s disease or in rare cases, a lymphoma.

Malignant Lesions

• Papillary Carcinoma

Papillary carcinoma accounts for about eighty percent of malignant lesions of the thyroid. This type of malignancy includes mixed papillary and follicular variants like the tall cell variant and the sclerosing variant. Two or more of the following cytological characteristics are suggestive of papillary carcinoma:

• nuclear inclusions, “cleared-out”, “ground glass” or “orphan annie” nuclei
• nuclear “grooves”
• overlapping nuclei
• psammoma bodies (which are rare)
• papillary projections with fibrovascular core
• “ropey” colloid

Follicular or Hurthle Cell Neoplasms

The lesions in this diagnostic category express characteristics that could be signs of malignancy but are not truly diagnostic. Factors that point to malignancy include male gender, a nodule size of more than 3 centimeters, and age greater than 40 years.

Definitive diagnosis requires histologic examination of the nodule to observe for capsular or vascular invasion. There are no genetic, histologic, or biochemical tests to date that are routinely used to differentiate between benign or malignant lesions in this category. Several studies show that thyroid peroxidase expression as measured by the monoclonal antibody MoAb 47 improves the specificity of correctly differentiating between benign and malignant neoplasms in FNA specimens. Galectin-3 has also been observed to be highly and diffusely expressed in follicular cell neoplasms but only minimally expressed in benign conditions.

Cytologic or histologic characteristics of a follicular malignancy include:

• minimal amounts of free colloid
• high density cell population of either follicular or Hurthle cells
• microfollicles

Cytologically, these lesions may be reported as:

• “Hurthle cell neoplasm”
• “Suspicious for follicular neoplasm”
• “Follicular neoplasm/lesion”
• “Indeterminate” or “non-diagnostic”

Medullary Carcinoma

Fifteen percent of malignancies of the thyroid are defined under this category. This type of thyroid malignancy should be suspected in patients with a family history of medullary cancer or multiple endocrine neoplasia Type 2.

Cytologic or histologic characteristics include the following:

• spindle-type cells with eccentric nuclei
• positive calcitonin stain
• presence of amyloid
• intranuclear inclusions ( which are common)

Anaplastic Carcinoma

In less than one percent of patients with malignant thyroid lesions, the diagnosis is anaplastic carcinoma. This type of malignancy is more common in elderly patients with a fast growing thyroid mass. These patients may have had a slow-growing mass for many years already. It is important that anaplastic carcinoma, which has limited therapy, be differentiated from thyroid lymphoma, for which there are ready treatments.

Cytologic characteristics of anaplastic carcinoma include the following:

• extreme cellular pleomorphism
• multinucleated cells
• giant cells

Thyroid Lymphoma

This is a rare form of thyroid malignancy. A rapid growth of a neck mass in the location of the thyroid gland in an elderly patient, especially in someone with Hashimoto’s thyroiditis, is suggestive of thyroid lymphoma. Cytologic features that could further point to this diagnosis include:

• monomorphic pattern of lymphoid cells
• positive B-cell immunotyping

Although thyroid fine needle aspiration is an important technique in the assessment of thyroid lesions, a patient is always free to ask for a second opinion, especially for something as serious as thyroid carcinoma. As pointed out earlier, it is also important for the examining pathologist or cytologist to differentiate between the different malignancies. A prompt and correct diagnosis could spell the difference between a quality life, disability, or even death.

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Fine Needle Aspiration

Liposuction, or fat removal, continues to be one of the most popular cosmetic surgery procedures across the world. For women in particular, liposuction can provide significant relief from those stubborn areas of fat that simply refuse to be eliminated through conventional methods of exercise and dieting. And as the number of people seeking liposuction continues to soar, developments in the sector have rapidly enhanced the variety of fat removal procedures available to cosmetic surgery patients.

For many surgeons and cosmetic clinicians, Smart Lipo (or laser lipolysis) is now becoming one of the most sought after treatments in the field. Unlike traditional liposuction, this is a non-invasive procedure through which fat cells are melted using laser technology rather than sucked out through a tube. However, further developments mean that patients can now choose between standard Smart Lipo treatments and Smart Lipo with Aspiration – a choice that is worth considering carefully before making a decision.

This difference between them is slight but significant. Essentially, the Smart Lipo process begins by injecting local anaesthesia into the area that is to be treated, in order to minimise any pain that may be caused by the procedure. Next, a powerful laser is used to melt the fat cells in the required bodily region, which breaks them down into liquid. Under a regular procedure, the liquefied fat will naturally seep out of the body for up to six months after the treatment.

However, with Smart Lipo with Aspiration patients will have the fat sucked out – or ‘aspirated’ – in order to speed up the effectiveness of the non-invasive surgery. This procedure is the preferred choice for many patients as it accelerates the rate at which the melted fat is secreted from the body and the results are immediate. As a result, this procedure is ideal for patients who want to see quick effects – for example, if you’re a bride hoping to show off your new figure at your wedding and a long recovery period is simply not feasible.

What’s more, Smart Lipo holds added appeal over liposuction for many people since it treats many areas that conventional fat removal methods cannot, such as the chin and neck. These areas of the body tend to be exposed nearly all the time, so speeding up the process with Aspiration is sure to deliver more satisfying results.

Similarly, if you’re about to go on a beach holiday and you want to get rid of any excess fat around your abdomen quickly, Smart Lipo with Aspiration is the natural choice for immediate results. This procedure poses obvious benefits over standalone Smart Lipo procedures.

However – as with any cosmetic surgery or treatment – it’s important to consult your surgeon on the risks and benefits before going ahead. After all, some side effects may still occur and it’s best to be aware of these prior to making your final decision if you’re going to get the maximum satisfaction from your fat removal treatment.