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PubMed1996

[Incidence of postmyelography syndrome and postmyelography complaints after lumbar puncture with the Sprotte pencil-like needle in comparison with the Quincke needle].

PURPOSE: Myelography in combination with a postmyelography CT is an important presurgical examination because of its excellent visualisation of the disc, the bone and the contrast-filled dura. Side effects after myelography can be observed in up to 50% of patients. The pathophysiological mechanism is thought to be increased cerebrospinal fluid leakage at the puncture site. Since the introduction by Sprotte in 1979 of the pencil-point needle, a modification of Whitacre's needle, fewer complaints after lumbar puncture have been reported. The aim of the study was to examine the influence of two types of needle points and the temperature (37 degrees C vs 21 degrees C) of the contrast medium (CM; iotrolan, Isovist) on the incidence of side effects of lumbar puncture for myelography. MATERIAL AND METHODS: In a prospective randomized trial the incidence of complaints after lumbar puncture with intrathecal CM application was evaluated by the use of a 21-G pencil-point needle as modified by Sprotte compared to our usual 22-G needle with a Quincke bevel. Some 412 patients (201 female, 211 male; mean age 54.05 +/- 7.4 years) were investigated. Directly after examination and 1. 3 and 5 days later the patients were questioned about complaints (headache, neck stiffness nausea, vomiting, buzzing in the ear and dizziness). The results were tested by the chi square test. RESULTS: A significantly lower incidence of complaints was seen after lumbar puncture with the pencil-point needle/Quincke needle (headache: 6.3%/18.9%, P < 0.0001; headache lasting 3 days: 0.5%/7.8%, P < 0.0001; headache lasting 5 days: 0%/2.4%, P = 0.0305; nausea: 0%/4.9%, P = 0.0009; vomiting: 0%/3.4%, P = 0.0009; dizziness: 0%/3.4%, P = 0.0074; neck stiffness: 0%/3.4%, P = 0.0074). The temperature of the CM had no influence on the complaints. No influence was seen on the quality of the myelogram. No relation to sex and age was found. CONCLUSION: Complaints after lumbar puncture and myelography are caused by the cerebrospinal fluid leakage at the puncture site. The incidence of side effects related to this leakage can be reduced by using a pencil-point needle. The temperature of the CM has no influence on the complaints.

Adolescent↗
PubMed2001

MRimaging findings after ventricular puncture in patients with SAH.

OBJECT: Using magnetic resonance (MR) imaging, we studied brain injury from ventricular puncture performed during craniotomy in the acute stage of subarachnoid hemorrhage (SAH). METHODS: 80 patients underwent craniotomy for aneurysm obliteration within 48 hr after SAH, ventricular puncture for drainage of cerebrospinal fluid (CSF) was performed to reduce intracranial pressure. MR imaging was performed within 3 days following surgery to measure the size of the lesion, and was repeated on postoperative days 14 and 30. CONCLUSIONS: Of the 80 patients with ventricular puncture preceding craniotomy, 65 (81%) showed MR evidence of brain injury from the puncture. Overall, 149 lesions were detected. According to coronal images, cortical injuries (54 cases), penetrating injury to tracts along the ventricular tube (55 cases), caudate injury (25 cases), and corpus callosum injury (15 cases). Brain injuries from ventricular puncture did not correlate significantly to patient outcome. While ventricular puncture and drainage of CSF can readily be performed to decrease brain volume at the time of craniotomy in acute-stage SAH, neurosurgeons should be aware of a surprisingly high incidence of brain injury complicating puncture.

Acute Disease↗
PubMed1987

Choice of an ovarian stimulation protocol according to the follicular puncture method in an in vitro fertilization programme.

In order to ascertain the adequacy of ovarian stimulation protocols with a type of follicular puncture, 126 women undergoing in vitro fertilization received either combination clomiphene/hMG or hMG alone according to a randomized test protocol. Within both groups patients for whom a pelvic examination was required had laparoscopies, while others had transvaginal ultrasonically guided punctures as far as possible. Clomiphene/hMG was more efficient than hMG alone as assessed from the cleavage rate (68% vs. 54%; p less than 0.01) and the pregnancy per attempt rate (16% vs. 5%; p less than 0.05). Laparoscopic punctures were more efficient than ultrasonically guided punctures (mean number of recovered oocytes: 4.8 +/- 2.6 vs. 3 +/- 2.5; p less than 0.001), but slightly better results were achieved by this latter method in ongoing pregnancy per puncture rate (18% vs. 8%; NS). With ultrasonically guided punctures, stimulation by clomiphene/hMG allowed better oocyte recoveries (3.8 +/- 2.5 vs. 2.3 +/- 1.9, p less than 0.05). Such results constitute an argument for preferential use of the clomiphene/hMG stimulation protocol with ultrasonically guided punctures.

Clomiphene↗
PubMed1986

Should computed tomography scanning replace lumbar puncture in the diagnostic process in suspected subarachnoid hemorrhage?

The role of lumbar puncture and computed tomography scanning for initial diagnosis of subarachnoid hemorrhage has been evaluated in a retrospective survey of 283 consecutive cases. The material has been divided into early-and late-diagnosed cases with 72 hours after bleeding as the demarcation line between groups. The early-diagnosed cases have been further subdivided into patients exhibiting contraindications for lumbar puncture, patients with a typical history of apoplectic headache, and patients presenting with a diffuse noncharacteristic history. Four initially alert patients suffered neurological deterioration associated with the performance of lumbar puncture, which corresponds to a complication rate of 2.2%. It is concluded that all cases of suspected intracranial hemorrhage in the pediatric age group should be immediately investigated by computed tomography. In old age, individual factors determining the patient's operability overshadows all other aspects. In the intermediate age group lumbar puncture is preferable to diagnose subarachnoid hemorrhage in cases first seen in a late stage, due to both the high rate of falsely suspected cases as well as the poor visualization of degenerating blood in the cerebrospinal fluid by computed tomography. In patients suffering severe apoplectic headache with nuchal rigidity, lumbar puncture is without question superfluous. If neck stiffness is not considered, 4.68 computed tomography investigations per 100,000 individuals would be performed yearly in falsely suspected cases, a diminishingly small cost corresponding to less than 1% of all cranial computed tomography scans performed in this region. Early-diagnosed patients with a diffuse atypical history constitute a small, low risk group for lumbar puncture. It may be acceptable in such patients to diagnose subarachnoid hemorrhage either by means of computed tomography or lumbar puncture, depending on the availability of local computed tomography resources.

Humans↗
PubMed1985

Lumbar puncture.

Lumbar puncture has been in widespread clinical use for nearly a century. It is used in emergency medicine primarily as a tool for the diagnosis of meningoencephalitis and subarachnoid hemorrhage. The development of computed tomography has changed the position that lumbar puncture has held in the diagnostic sequence of a number of clinical entities. The procedure is contraindicated if there is soft-tissue infection adjacent to the puncture site and if there are findings of increased intracranial pressure due to a mass lesion. Performance in the setting of a coagulopathy may also be hazardous. The most serious potential complication is cerebral herniation. The commonest complication is postlumbar puncture headache, which is due to CSF hypotension resulting from persistent spinal fluid leakage through the meningeal puncture site. Spinal hematoma, diplopia, and intraspinal dermoid tumor formation are less common complications. Meningitis has been found to follow lumbar puncture in children with bacteremia. The lumbar puncture is a useful test for providing information regarding the cellular, chemical, and microbiologic composition of the CSF. Fluid obtained should be evaluated for cell count, Gram's stain, bacterial culture, glucose and protein levels, and other tests as clinically indicated.

Cerebrospinal Fluid↗
PubMed1992

Safety of arteriography by direct puncture of a vascular prosthesis.

A total of 122 catheterizations were performed in 105 patients with femoral grafts. Ninety-five femoral grafts were punctured. The mean follow-up time was 21 months. Sixty-one patients had follow-up duplex ultrasounds of the graft puncture site at 6 months. The complication rates for patients with direct graft puncture were comparable to those of patients without grafts undergoing femoral catheter arteriography. Twenty-seven cases with femoral grafts had arteriography using the transaxillary technique. The overall complication rate for the 95 cases with graft puncture was 12% (8% were minor complications) in contrast to 30% (22% were major complications) for the 27 cases with the transaxillary approach. The local, nervous system, and major complication rates were all significantly less in patients with graft puncture than in patients with the transaxillary approach. There was no evidence of early or late pseudoaneurysm formation, disruption of the suture line, or late graft infection in patients with graft puncture. Direct graft puncture arteriography is safe and preferable to the transaxillary approach.

Angiography↗
PubMed2003

Simple and safe puncture technique for voice prosthesis implantation.

OBJECTIVE: A simplified esophagotracheal (ET) puncture technique is described for use instead of the Blom-Singer method for voice prosthesis implantation, with the aim to offer an easier alternative for the same purpose. Study population Of 68 study patients, there were 10 women and 58 men (age range, 46 to 80 years) who had been operated on during a 5-year period with use of this technique. Of the 68 patients, 57 were able to learn to speak in a fluent voice acceptable for everyday communication after the implantation. Seven of the 57 patients had a spasm in the cricopharyngeus muscles and were able to speak only after myotomy. METHODS: Sixty-eight patients were implanted with voice prosthesis using the ET puncture technique as follows: through the laryngoscope, the distal bent blunt end of the endoextralaryngeal needle carrier is led into the esophagus. The needle with the leading thread (2-0 Prolene) is pushed through in the upper third of the tracheostoma from inside out. Afterward, the cone-trocar catheter is pulled through the stitching canal in the upper third of the tracheostoma. Using the ET puncture technique, the puncture site is the same as with the use of the Blom-Singer method, 5 to 8 mm below the mucocutaneous junction. Then the cone-trocar is cut off from the 18 charrier catheter and the guide wire is pushed inside the catheter through the esophagus, pharynx, and mouth. The voice prosthesis will be fixed on the guide wire and then pulled back in the opening of the fistula. RESULTS: There were no problems or complications with this technique. In 4 cases, the ET puncture could be performed on patients in whom it was not previously possible with the Blom-Singer technique. CONCLUSION: This management approach offers an alternative to the Blom-Singer technique. The advantage of the ET puncture is that it is simple and safe and that the back wall of the pharynx or esophagus cannot be damaged. Using the ET puncture technique, the possibility of complications is eliminated.

Aged↗
PubMed1993

Safety of lumbar puncture in patients with hemophilia.

STUDY OBJECTIVE: To determine the safety of lumbar puncture in patients with hemophilia who are pretreated with clotting factor. DESIGN: Retrospective analysis of medical records between 1980 and 1990. SETTING: Three hospitals, each serving as a regional hemophilia center. PARTICIPANTS: Thirty-three patients with hemophilia A or B who received one or more lumbar puncture. INTERVENTION: All patients received replacement of deficient factor before the lumbar puncture. Serious post-lumbar puncture complications were defined as motor or sensory deficits, incontinence, or documented intraspinal hemorrhage. RESULTS: Thirty-three patients with hemophilia A or B received a total of 52 lumbar punctures during the study period. Thirty of 33 patients (91%) had severe baseline factor deficiency, two (6%) had moderate deficiency, and one (3%) had mild deficiency. There were no serious complications reported as a result of the lumbar puncture. The 95% confidence interval for the risk of a serious complication was 0% to 5.8%. CONCLUSION: With adequate factor replacement, a lumbar puncture can be done safely in patients with hemophilia.

Adolescent↗
PubMed2000

Respiratory jugular venodilation: a new landmark for right internal jugular vein puncture in ventilated patients.

OBJECTIVE: To report a new technique for right internal jugular vein puncture using respiratory jugular venodilation as a landmark for vein location. DESIGN: Prospective observational study. SETTING: Single community hospital. PARTICIPANTS: Two hundred patients undergoing right internal jugular vein cannulation under general anesthesia. INTERVENTIONS: Catheter placement was attempted using respiratory jugular venodilation as the primary landmark. When it was not applicable, an alternative technique using the carotid pulse as a landmark was used. MEASUREMENTS AND MAIN RESULTS: Visibility of the venodilation, the number of needle passes, the success rate, and the incidence of arterial puncture were analyzed. Respiratory jugular venodilation was observed in 158 patients (79%). In this group of patients, the jugular vein was cannulated at the first attempt in 83.5% of patients, and arterial puncture occurred in one patient (0.6%). In the remaining 42 patients (21%) lacking the visible venodilation, catheter placement was accomplished at the first attempt in 42.9% of patients (p<0.01 v. the venodilation-visible group), and 4 patients (9.5%) suffered arterial puncture (p<0.01). The overall incidence of arterial puncture was 2.5%. The success rate of cannulation (within four needle passes and no arterial puncture) was 98.1% in the venodilation-visible patients and 73.8% in the others (p<0.01), with the overall success rate of 93%. CONCLUSIONS: Respiratory jugular venodilation can be identified in a large proportion of ventilated patients. This experience suggests that respiratory jugular venodilation could be favorably used as the primary landmark for right internal jugular vein puncture in anesthetized patients.

Adult↗
PubMed2001

Effects of repeated follicular punctures on ovarian morphology and endocrine parameters in dairy heifers.

Three experimental and three control heifers were included in the study. After a control period (CP), the experimental heifers were subjected to 4 and 5 weeks of twice-weekly follicular punctures (FPP1 and FPP2) with two oestrous cycles in between. The follicular punctures were performed using the ovum pick-up (OPU) technique. During the CP and FPPs, ovarian activity was monitored by transrectal ultrasonography and analyses of plasma progesterone, prostaglandin F2alpha (PGF2alpha) metabolite, luteinizing hormone (LH), oestradiol and follicle stimulating hormone (FSH) levels. The animals were slaughtered 7 days after cessation of FPP2 and their ovaries examined. The control animals were monitored for their oestrous cyclicity and were then ovariectomized and the ovaries examined. Despite the absence of ovulation, the formation of corpus luteum (CL)-like structures could be ultrasonographically observed during FPPs. These structures either had characteristics comparable to those of the CLs during the CP (group 1) or were smaller and had a shorter life span and (or) luteal active phase with a lower progesterone production (group 2). In group 1, CL-like structures emanated from punctures of large-sized follicles on or close to the days on which the animals showed oestrus and had a rise in oestradiol and LH. In group 2, the structures developed from punctures of smaller-sized follicles and no oestrus nor a detectable 1.14 rise was revealed around punctures. During most FPPs, the basal level of LH was at zero. During all FPPs, a significant rise in FSH level occurred on the day following the day of puncture. To conclude, repeated follicular puncture appeared to alter slightly endocrine profiles and cause minor morphological changes in the ovaries. Both the macro- and microscopic examinations revealed the presence of luteal structures and follicles of various sizes in the ovaries of all heifers studied. The connective tissue in the ovarian tunica albuginea of the experimental heifers was significantly thicker than that in controls (P < 0.001).

Animals↗
PubMedDate not supplied

Postlumbar puncture headache and its relation to chronic tension-type headache.

One hundred consecutive patients, the majority suffering from bilateral chronic tension-type headache, investigated with lumbar puncture, were studied as to age, sex, body mass index, diagnosis, lumbar cerebrospinal fluid pressure, and signs of inflammation in the serum in relation to postlumbar puncture headache. Patients younger than 40 years of age were significantly more prone to develop postlumbar puncture headache than patients older than 40 years of age (P = 0.01). Sex, body mass index, cerebrospinal fluid pressure, and signs of inflammation in the serum were not related to the frequency of postlumbar puncture headache in the present study. Postlumbar puncture headache occurred significantly more often in patients with bilateral chronic tension-type headache than in patients with unilateral headache (P = 0.02) and in patients without headache (P < 0.01). In a regression analysis with age, sex, and chronic tension-type headaches, only bilateral headache contributed significantly to the prediction of postlumbar puncture headache (P < 0.01). Age did not contribute apart from the common variance with chronic tension-type headache/no chronic tension-type headache. The results may indicate that postlumbar puncture headache and chronic tension-type headache have etiologic mechanisms in common, mechanisms presumably localized intracranially rather than extracranially.

Adolescent↗
PubMedDate not supplied

Autologous fat injection to treat leakage around tracheoesophageal puncture.

PURPOSE: To evaluate prospectively autologous fat injection as a treatment for leakage around tracheoesophageal puncture. PATIENTS AND METHODS: For ten patients who exhibited leakage of saliva or liquid around their tracheoesophageal puncture, autologous fat injection was carried out into the tracheoesophageal wall around the maintained prosthesis. Short-term success was evaluated at one month, and long-term follow-up was continued as long as the patients remained alive. The effectiveness of the procedure was evaluated based on the presence or absence of leakage around the puncture as the patient swallowed methylene blue liquid. Patients were adjudged completely improved when no leakage of blue liquid was observed, partially improved when a slight stasis was evident, or unimproved when a marked leakage of blue liquid was noted. RESULTS: Short-term success was achieved for 6 patients, 2 patients partially improved, and the procedure failed for 2 others. Long-term success (from 10 to 65 months) was achieved in all 4 of the completely improved patients who were free of disease, including 1 patient who required an additional injection. Removal of the puncture was later carried out in the 2 others for cervical node metastases or tracheal tumor. Definitive or transitional puncture closure or removal of the prosthesis was required in 3 partially or unimproved patients, whereas 1 partially improved patient died of lung metastasis 3 months later. CONCLUSIONS: Fat injection around a voice prosthesis is a procedure that may be conducted as an alternative to other conservative techniques to decrease the size of the puncture. Close endoscopic observation is required however to eliminate secondary tumor that might expand the size of the puncture.

Adipose Tissue↗
PubMed2003

Is primary endoscopic puncture of ureterocele a long-term effective procedure?

BACKGROUND/PURPOSE: For more than a decade, endoscopic puncture of ureterocele has been recommended as an initial and, in the majority of the patients, as a definitive procedure. This study evaluates the long-term effectiveness of primary endoscopic puncture of ureterocele. METHODS: Over the last 18 years (1984 through 2001), 52 patients (median age 3 months) underwent primary endoscopic puncture of ureterocele. The median follow-up was 9 years (6 months to 18 years). Antenatal ultrasound scan detected hydronephrosis and led to the postnatal diagnosis of ureterocele in 12 (23%) children, whereas in the remaining 40 (77%) children the diagnosis was made on investigation for urinary tract infection (UTI). The ureterocele presented as a part of renal duplication in 48 (92%) patients and a single system in 4 (8%). Forty-four (92%) of the patients with duplication presented with non- or poorly functioning upper poles. Vesicoureteric reflux (VUR) was seen in the lower moiety of the ipsilateral kidney in 31 and in 18 of the contralateral kidney comprising 49 renal refluxing units (RRU). RESULTS: Complete decompression of the ureterocele was achieved in 48 (92%) patients after the first endoscopic puncture. Four (8%) patients required a second puncture of ureterocele. Nine (17%) of the 52 patients underwent nephrectomy for a nonfunctioning kidney. Ten (19%) patients required upper pole partial nephrectomy owing to nonfunctioning upper pole. Twenty-nine (59%) of the 49 RRU showed spontaneous resolution of VUR. Sixteen (33%) RRU underwent endoscopic correction of VUR. One required ureteric reimplantation. The remaining 4 (8%) are maintained on prophylactic antibiotics. Five (10%) patients had VUR in the upper pole moieties after ureterocele puncture. CONCLUSIONS: Our data suggest that primary endoscopic puncture of ureteroceles is a simple, long-term, effective, and safe procedure avoiding complete reconstruction in the majority of the patients.

Child↗
PubMed2002

[Ultrasound-guided puncture of the subclavian vein to implant central venous ports].

PURPOSE: To assess the safety and efficacy of ultrasound guided puncture of the subclavian vein instead of blind puncture or surgical procedure. The advantages compared with implantation of brachial ports are demonstrated. PATIENTS AND METHODS: In 41 oncologic patients the subclavian vein was punctured by ultrasound guidance in order to implant a port (34 left side, 7 right side). The study included 21 women and 20 men (range 34 - 79, mean 61 years). Imaging of the subclavian vein was performed with a 7,5 MHz linear ultrasound probe in B-mode and in colour doppler mode. Puncture was performed under ultrasound control (18 G, 45 mm needle when skin-vessel distance was < 3 cm, 19 G, 75 mm needle when skin-vessel distance was > 3 cm). In 27 patients a Bardport was implanted, in 14 patients a Vitalport (Cook). In three patients surgical port implantation failed. One of these patients had a partial thrombosis of the subclavian vein. RESULTS: Technical success was 100 %. In one patient we first punctured the subclavian artery at the beginning of our series without any complication. All port systems could be implanted. There was one haematoma in the port pocket without any effect to the port function. In the three surgical patients subclavian vein puncture and portimplantation was successful. CONCLUSION: Ultrasound guided puncture of the subclavian vein and port implantation by radiologists is a save procedure. A low risk approach to the subclavian vein is possible at any location. The long approach through the cubital vein with brachial port implantation is not necessary.

Adult↗
PubMed1984

Aortofemoral bypass grafts: safety of percutaneous puncture.

To assess the safety of percutaneous puncture for the angiographic study of aortofemoral bypass grafts, we reviewed the medical records of 58 patients who underwent a total of 86 graft punctures. Short- and long-term follow-up revealed that in 83 punctures there were no complications. In three instances (3.5%) there was acute thrombosis of the punctured limb of the graft. This complication may have expedited but did not substantially alter the surgical plans of managing the underlying clinical problem. Although the incidence of complications of direct graft puncture is higher than that associated with puncture of native vessels, alternative approaches are also associated with complications, many of which may be more serious. Therefore, for angiographic studies of patients with aortofemoral bypass grafts, we favor the direct percutaneous puncture provided that enough time has elapsed from surgery.

Adult↗
PubMed2005

Computed-tomography-guided punctures using a new guidance device.

PURPOSE: To evaluate a new adjunctive guidance device, a puncture guide, constructed to simplify computed tomography (CT)-guided punctures and to make the procedure more accurate and safe. MATERIAL AND METHODS: 17 patients referred for CT-guided punctures were included in the study. There were 10 thoracic and 7 abdominal or pelvic lesions with a mean maximum diameter of 29 +/- 18 mm. All punctures were performed using a laser guide combined with the new device. The needle guide created a streak artefact in the image, indicating the needle path. RESULTS: The puncture was successful at the first attempt in 15 of the 17 patients. The artefact was visible in all patients, and in the majority there was a distinct artefact reaching from the entry point to the lesion. The deviation between the angle of the streak artefact and the final angle of the needle was 1.1 degrees. CONCLUSION: The benefits of the puncture guide were the artefact pointing at the target, the needle support, and accuracy when performing CT-guided punctures.

Abdominal Cavity↗
PubMedDate not supplied

A collagen coated fabric vascular prosthesis as a punctureable A-V shunt.

A fabric vascular prosthesis sealed with succinylated collagen (SC) was developed as an arteriovenous (A-V) shunt graft for hemodialysis. The SC graft was soft, pliable, flexible, and puncturable, with quick hemostasis. A needle puncture made a smaller hole in the SC graft wall than in a control expanded-polytetrafluoroethylene (e-PTFE) graft such as is usually used for an A-V shunt. The SC graft was extremely hydrous, because it is sealed with water, which is absorbed into the intermolecular spaces of negatively charged collagen. The SC suspension was injected with pressure into a knitted fabric vascular prosthesis wall (water permeability, 1,200 ml) so as to become entangled in the Dacron network. The graft then was lyophilized and thermally cross-linked. Water leakage from six holes created by an 18 G needle puncture in vitro under water pressure of 120 mmHg was 34.5 +/- 29.9 ml/min in the SC graft and 169.9 +/- 38.5 ml/min in the control e-PTFE graft. Hemostatic time at six 18G needle puncture sites on grafts implanted in the abdomen of 12 dogs was 4.5 +/- 2.5 mins in the SC graft and 34.2 +/- 11.5 mins in the control graft. After implantation, the luminal surface of the SC grafts had a thinner thrombus layer than did the control grafts. After 1 week, a thin thrombus layer covered the luminal surface of the SC grafts, and puncture sites were recognized as small dots under it, but in the control grafts, the thrombus layer was thick and the puncture sites could not be seen. These results suggest that the SC graft is less thrombogenic and has less blood leakage from the puncture sites than does the control graft.

Animals↗
PubMed2000

Value of antral puncture in the intensive care patient with fever of unknown origin.

OBJECTIVE: To evaluate the use of maxillary sinus puncture as a routine diagnostic procedure to exclude or confirm purulent sinusitis in intensive care unit (ICU) patients presenting with fever or a septic state of unknown origin. STUDY DESIGN: Retrospective. METHODS: All patients admitted to the ICU at the University Hospital Ghent who required ENT examination to exclude acute sinusitis as possible cause of their otherwise inexplicable fever or septic state underwent maxillary sinus puncture via the inferior meatus. The results of clinical examination and the relation between the presence of foreign bodies (e.g., nasogastric tubes) and culture results from the middle meatus and sinuses were analyzed. RESULTS: One hundred five punctures were performed in 53 patients. Macroscopic purulent effusions were obtained from 25 and nonpurulent effusions from 19 sinuses. The presence of a nasogastric tube did not influence puncture results but significantly increased colonization of the middle meatus. Staphylococcus aureus and Gram-negative agents were frequently cultured from sinus aspirates. Although purulent secretions often reveal no growth, most patients present with a multibacterial (40%) or monobacterial (28%) infection. Simple anterior rhinoscopy reduces the need for antral puncture. Only 8% of punctures in patients with a normal clinical examination were positive. CONCLUSIONS: Antral puncture proves to be a simple, fast, safe, inexpensive, and effective procedure for immediate diagnosis of acute nosocomial sinusitis in ICU patients and is therefore recommended as first procedure in these patients, even when only minor clinical abnormalities are present.

Adolescent↗