Fine needle lung aspiration biopsy is now a well established method of obtaining tissue for histopathological diagnosis. It is fast, simple and reliable, and has a very low complication rate. We report our experience using two fine needles, the Turner and the EZ-EM Cut-Biopsy needles, comparing their yield and complication rates. We found that both needles had comparable diagnostic yields (65% with the Turner, and 71% with the EZ-EM) and complication rates. We also found that in most cases, aspirates alone were sufficient for diagnosis, and that obtaining tissue cores with larger bore EZ-EM needles did not significantly influence the diagnostic outcome. We conclude that both the Turner and the EZ-EM needles are equally effective and safe in percutaneous lung aspiration biopsy. The least traumatic needle should be used except when the cytological diagnosis is nonspecific inflammatory cells or inadequate, in which case a repeat with a cutting needle is advised to obtain a core of tissue.

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Although adult hypertrophic pyloric stenosis (AHPS) is an uncommon condition, there are nine reports of true pyloric muscle hypertrophy with, in addition, infiltration of gastric carcinoma cells between the muscle fibres' -5 . The surgeon should be aware of this association when operating on a patient with AHPS as a full-thickness biopsy is essential for identification of simple AHPS and certain exclusion of carcinoma. The patients presented here lead us to recommend partial gastrectomy as the treatment of choice in all cases of hypertrophic pyloric stenosis in adults. Case reports Case 1A 47-year-old hypertensive man developed copious vomiting of bile-free food in 1975. Adult hypertrophic pyloric stenosis (AHPS) was diagnosed after two barium meals and three gastroscopies without biopsy. He underwent truncal vagotomy and Weinberg pyloroplasty without biopsy. Nine months postoperatively he developed recurrent dyspepsia. Gastroscopy showed a friable prepyloric lesser curve with gastritis and intestinal metaplasia (but no malignancy) on biopsy. The pylorus was wide open. His symptoms were temporarily controlled with metoclopramide but recurred in 1978 when gastroscopy showed a pale, smooth antral lesser curve without ulceration. No biopsy was taken. The pylorus was open. In 1982 he developed belching and halitosis. Barium meal showed recurrent pyloric stenosis. At laparotomy the pyloric muscle was thickened with narrowing of the canal. A 50 per cent Polya gastrectomy was carried out (Figure 1). Examination of the specimen showed that the wall of the pyloric canal was thickened (26 mm) by muscle hypertrophy. In addition there were slender cords of signet-ring adenocarcinoma cells running through the hypertrophied muscle and an ulcerating poorly differentiated carcinoma on the prepyloric lesser curve with serosal extension and lymph node involvement. Five months later he died with disseminated intra-abdominal carcinoma. Case 2A 57-year-old man with ischaemic heart disease developed dyspepsia, weight loss and vomiting over nine months. Barium meal and gastroscopy showed pyloric stenosis. Biopsy of the prepyloric area showed undifferentiated signet-ring adenocarcinoma. He underwent Polya gastrectomy. The wall of the pyloric canal was 23 mm thick with marked muscle hypertrophy and diffusely infiltrating signet-ring malignant cells, very similar to case 1. DiscussionAdult hypertrophic pyloric stenosis (AHPS) is a curious condition. Although responsible for up to 2 per cent of cases of pyloric obstruction in adults6 only about 300 cases are reported in the literature7. This discrepancy may be partly due to a lack of awareness of the adult type of pyloric muscle hypertrophy in contrast to the well recognized congenital form. Most patients are between 30 and 60 years old at presentation and male predominance is not as marked as in the congenital type'. The classification of AHPS suggested by Berk' stresses that some cases are primary or idiopathic but the majority are associated with some local ulcerative or inflammatory co...

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