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At least 253 records · Page 14Linked to original sources
PubMed2005

[Use of direct portal vein puncture portography with modified TIPS treatment in patients with portal hypertension and gastro-esophageal varices bleeding].

OBJECTIVE: To explore a better procedure for transjugular intrahepatic portosystemic shunt (TIPS) in order to improve its safety and to extend its indications. METHODS: To puncture the right portal branch under sonographic guidance in 20 patients with portal hypertension and gastro-esophageal bleeding. The Teflon sheath with gold marker was put into the portal vein; anterior and lateral portography was made, portal pressure was measured and the gastric coronal vein was embolized. The gold marker was put into the portal vein puncture site and the Rups-100 was guided under the gold marker during the TIPS puncture procedure. Anterior and lateral portography was again made to make sure the puncture site was 2 cm away from the portal vein bifurcation. In some cases a 10F sheath was used to suck the thrombosis in the portal vein, and a balloon was used to dilate the parenchyma channel and then a stent was released smoothly. RESULTS: 20 reformed TIPS were successfully performed on all patients and their gastric-esophageal bleedings were controlled immediately. 37 punctures were made in 20 of those cases; the average puncture per patient was 1.85+/-0.67, lower than that of the traditional method. The pressure of the portal vein declined from (30.5+/-1.1) mmHg to (16.9+/-0.9) mmHg, P < 0.05, showing that the difference of portal vein pressure before and after the reformed TIPS was significant. 25 stents were placed, and no complications occurred during the procedure in any of the cases. CONCLUSION: Direct portal vein puncture portography and gold marker guided TIPS procedure is feasible and safe; the indications of TIPS could be further extended.

Adult↗
PubMed2005

Effect of blood-letting puncture at twelve well-points of hand on consciousness and heart rate in patients with apoplexy.

OBJECTIVE: To observe the effect of blood-letting puncture at Twelve Well-Points of Hand on consciousness and heart rate in patients with early apoplexy. METHOD: Under observation were patients with disturbance of consciousness within 3 days after the apoplectic seizure. The patients were divided into a large injury team, a moderate injury team and a mild injury team. Each team was again randomly divided into a puncture group and a control group, with routine treatment in both groups but blood-letting puncture only in the puncture group. Quantitative changes in consciousness, blood pressure and heart rate of the patients were observed. RESULT: Blood-letting puncture at Twelve Well-Points of Hand can improve the consciousness and raise the systolic pressure in patients of the mild injury team, and accelerate the heart rate in all the patients in the puncture group. CONCLUSION: Blood-letting puncture at Twelve Well-Points of Hand can improve the consciousness of patients with brain injury in small area.

Acupuncture Points↗
PubMed1995

Teratogenic effects of amniotic sac puncture: a mouse model.

The possibility of an association between chorionic villus sampling (cvs) and limb abnormalities has prompted a review of the relevant experimental data. Although a vascular aetiology is favoured by many at present, the possibility exists that a proportion of cases may be caused by oligohydramnios secondary to inadvertent amniotic sac puncture. A mouse model of amniotic puncture syndrome has been developed to study the craniofacial and limb abnormalities produced by this procedure. Pregnant mice were anaesthetised and a laparotomy performed. One uterine horn was exteriorised, and the amniotic sacs punctured through the wall of the uterus with either a 21 gauge or a 25 gauge needle. The conceptuses in the contralateral uterine horn acted as controls. The mice were all killed on d 19 of pregnancy (day of finding a vaginal plug = d 1 of pregnancy) by cervical dislocation, and the morphological features of the embryos examined in detail. In a preliminary study, amniotic sac puncture was carried out on d 12, 13, 14, 15 or 16 of pregnancy, with either a 21 or a 25 gauge needle. Since the highest rates of palatal defects and limb deformities were observed following amniotic sac puncture using a 21 gauge needle, when this procedure was carried out on either d 13 or 14 of pregnancy, the main study was undertaken using a 21 gauge needle on these two days of pregnancy. Of 102 embryos in which amniotic sac puncture was carried out on d 13, 53% survived to d 19. Of the latter, 35% had a cleft palate, 61% had one or more morphologically abnormal limbs, and 43% had an abnormal tail. When amniotic sac puncture was carried out on d 14 of pregnancy, of 83 embryos subjected to this procedure, 81% survived to d 19. Of the latter, 27% had a cleft palate, 39% had one or more morphologically abnormal limbs, and 19% had an abnormal tail. In the controls, of 86 and 61 embryos isolated respectively from the d 13 and 14 mice, the survival rates were 97 and 90%, respectively. Palatal, limb and tail abnormalities were not observed in the control series. Tentative relationships are drawn between cvs and amniocentesis-associated abnormalities, the Robin sequence and their rodent phenocopies.

Amnion↗
PubMed1995

Endosonographically guided transduodenal and transgastral fine-needle aspiration puncture of focal pancreatic lesions.

Mass lesions of the pancreas can be clearly visualized by endoscopic ultrasonography. For the differentiation of benign from malignant mass lesions, however, cytological examination is still recommended. As transcutaneous fine-needle biopsies have a limited diagnostic value, we have evaluated the efficiency of transmural (trangastral, transduodenal) endosonographically guided fine-needle aspiration (EUS-guided FNA) puncture for cytological confirmation of such pancreatic mass lesions. EUS-guided FNA puncture was performed in 11 patients with focal pancreatic solid lesions. In 4 patients a malignant mass lesion and in 2 patients a benign lesion were correctly identified by EUS-guided FNA puncture, while in 4 patients a false benign diagnosis was established and in 1 patient with a malignant mass lesion a sufficient cytological sample could not be obtained. Histological confirmation or rejection of the cytological diagnosis gained by EUS-guided FNA puncture was obtained in all patients by surgical biopsy or resection. It is concluded that transmural EUS-guided FNA puncture-with the application of a curved-array EUS transducer scanning parallel to the axis of the endoscope-is a new approach to the cytological diagnosis of pancreatic mass lesions. However, the of flexible puncture needles with a short needle tip-destined for multiple use-results in a considerable amount of false-negative diagnoses, as the needle tip frequently can only be advanced into the margin of the lesion. New prototypes of aspiration needles with an extending steel are presently under study for improved transmural EUS-guided FNA puncture.

Aged↗
PubMed1997

[Cardiotocographic changes after umbilical cord puncture and umbilical cord transfusion].

In connection with umbilical cord punctures and transfusions the degree of pathology still tolerable after these procedures as well as the influence on subsequent obstetric management has to be discussed. In a prospective study we evaluated 98 cordocenteses with (n = 44) and without (n = 54) transfusion (25-37 week of gestation). 30-160 ml of blood were transfused. In all cases the umbilical vein was punctured at the point of insertion into the placenta (46x posterior and 52x anterior wall placenta). A CTG was performed prior and after the punction and was evaluated according to the Fischer score. After the procedure, the course of pregnancy was normal in all puncture patients and in 52 of 54 patients who also underwent a transfusion. Because of a pathological CTG due to a severely hydroptic fetus, a caesarean section had to be performed in one woman seven hours after umbilical cord transfusion. In another patient an emergency section was necessary immediately after the umbilical cord transfusion, due to persistent fetal bradycardia. In the puncture group mean Fischer score values decreased from 9.1 to 7.5, in the transfusion. In another patient an emergency section was necessary immediately after the umbilical cord transfusion, due to persistent fetal bradycardia. In the puncture group mean Fischer score values decreased from 9.1 to 7.5, in the transfusion group from 8.6 to 7.4. The results were more unfavorable when amplitude and occurrence of accelerations were considered, especially in the transfusion group. In one fifth of the puncture cases and one fourth of the transfusion patients the criterium of baseline crossings improved after the procedure. In summary, a pathological CTG is to be expected after umbilical cord punctures and transfusions, with however, only the necessity of surveillance. Only in cases of persistent fetal bradycardia an active obstetric management is indicated.

Blood Transfusion, Intrauterine↗
PubMed2006

Postdural puncture headache: a cross-sectional study of incidence and severity in a new obstetric anaesthesia unit.

Postdural puncture headache remains a major complication of subarachnoid anaesthesia that bothers the anaesthetist and the young mother. Identification of factors that may affect PDPH after caesarean section under subarachnoid anaesthesia could be critical to policy formulation in an emerging obstetric anaesthesia unit. All patients who had caesarean section under subarachnoid anaesthesia were evaluated in a cross-sectional manner. Only patients in whom 25G Quincke needles were employed for lumbar puncture were recruited for analysis. Patients who met criteria for postdural puncture headache were interviewed on postoperative day 3. The PDPH was further characterized to establish the time of onset, location of headache, limitation of activity of daily living, and methods of management. A total of 119 patients had lumbar puncture for spinal anaesthesia. Spinal anaesthesia was successful in 112 patients, inadequate in 6 patients and failed in one. Twenty-seven patients (22.7%) developed PDPH. There was no difference in the demographic features in the patients who developed PDPH and those without headache. Clinical variables like site and number of attempts at dural puncture (p = 0.82. Chi-square test), traumatic attempts. parasthesia and volume of bupivacaine were not found to be determinants of PDPH. Successful dural puncture was achieved on first attempt in 42.0% (n = 47) of the patients. The PDPH was mainly occipital for most of the women, starting on postoperative day 2 and relieved with liberal fluids and paracetamol. Maternal experience of their caesarean section with spinal anaesthesia was satisfactory in 77.8% (n = 21) of patients and 63% (n = 17) would recommend the technique to other women.

Adult↗
PubMed1996

Effect of puncture resistant surgical gloves, finger guards, and glove liners on cutaneous sensibility and surgical psychomotor skills.

New puncture and cut resistant hand protection systems have been developed to enhance the barrier to cuts and needle puncture injuries during surgical procedures. It is important, however, that these new hand protection systems do not reduce tactile sensitivity or dexterity during surgery. Consequently, it was the purpose of this report to compare the cutaneous sensibility and dexterity of physicians' hands covered by these new puncture and cut resistant hand protection systems to that of the standard surgical latex glove. The hide (Medak) portion of the Life Liner and the polyethylene (Spectra) portion of the FingGuard, which offered the greatest resistance to needle puncture, were associated with the greatest reduction in cutaneous sensibility, as determined by moving and static two-point discrimination, aesthesiometer pressure sensation, and discrimination of suture size and configuration. In addition, the physicians believed that the puncture and cut resistant Life Liner glove liner markedly interfered with their handling of surgical instruments. The ultimate benefit of these puncture and cut resistant hand protection systems must be determined in well-controlled clinical trials.

Discrimination, Psychological↗
PubMed1992

Atrial septal puncture technique in percutaneous transvenous mitral commissurotomy: mitral valvuloplasty using the Inoue balloon catheter technique.

Transseptal catheterization is a vital component of percutaneous transvenous mitral commissurotomy. Therefore, a well-executed transseptal catheterization is the key to a safe and successful percutaneous transvenous mitral commissurotomy. Two major problems inherent in atrial septal puncture for percutaneous transvenous mitral commissurotomy are cardiac perforation and puncture of an inappropriate atrial septal site. The former may lead to serious complication of cardiac tamponade and the latter to possible difficulty in maneuvering the Inoue balloon catheter across the mitral orifice. This article details atrial septal puncture technique, including landmark selection for optimal septal puncture sites, avoidance of inappropriate puncture sites, and step-by-step description of atrial septal puncture.

Balloon Occlusion↗
PubMed1979

Ultrasonic real-time guidance for percutaneous puncture.

Real-time scanning was applied to the sonically guided puncture technique. A special puncture attachment connected to the ultrasound sector scanner was developed for this purpose. A puncture needle is introduced into the scanning plane through the canal in the attachment. Excellent real-time images of both the target lesion and the needle can be clearly seen on the oscilloscope during the puncture procedure. Puncture not only for cystic structures but also for solid masses can be made easily and safely by this new technique. Successful applications of the technique have been carried out for renal cyst puncture, percutaneous antegrade pyelography, percutaneous nephrostomy, percutaneous renal biopsy, and perineal prostatic biopsy.

Kidney Diseases↗
PubMed1976

Effect of needle puncture and intradermal fluid injection on epidermal cell kinetics of albino guinea-pig skin.

The flanks of male albino guinea pigs were used to study the effect of needle puncture with or without intradermal (id) injection of 0.1 ml fluid. The center of the raised bleb was marked and biopsies taken 1,4,8,24,50 and 72 hrs after needle puncture and 1 hr after intraperitoneal (ip) injection of tritiated thymidine (3H-TdR). There were no significant differences in labeling index (LI) or mitotic index (MI) 1 hr after id, ip, or subcutaneous (sc) injection nor in percent labeled mitoses, 7 hrs after id or ip injection. The earliest increase in LI (180% above control) occurred 12 hrs after needle puncture, peaked at 24 hrs (ca. 3X control), and returned to control level by 50 hrs. The area affected had a radius of about 5 mm from the point of needle entry or center of the bleb. Within 12 hrs after needle puncture, there was an increase in labeled cells primarily at the periphery of the bleb area, about 4 mm from the point of needle entry. By 24 hrs, the distribution of labeled cells had moved toward the bleb center (LI = 65%). The first increase in mitoses (MI = 2.5%) was seen 24 hrs after needle puncture. It is concluded that id injection introduces no significant error in LI or MI to 8 hrs after needle puncture. It does, however, trigger many noncycling basal cells into DNA synthesis after 8 hrs, and this may increase the rate of transit of these cells to the granular layer.

Animals↗
PubMed1994

Atraumatic needle reduces the incidence of post-lumbar puncture syndrome.

We investigated the occurrence of the post-lumbar syndrome (PPS) in relation to the puncture technique used, in a prospective randomised double-blind study comprising 100 patients. A new atraumatic 22-gauge cannula was compared with a 20-gauge cannula with a Quincke bevel. The atraumatic cannula is a needle with a tip shaped like a closed circular cone with a lateral opening, usually used with an outer cannula (introducer). The study showed that both the frequency of PPS and of acute complaints during lumbar puncture can be dramatically reduced with the atraumatic puncture technique. A marked PPS occurred after lumbar puncture with the 20-gauge cannula in 31% of patients, whereas only 5% of patients reported marked post-puncture symptoms after lumbar puncture with the atraumatic cannula.

Adult↗
PubMed2002

Puncture of the popliteal artery using a Doppler-equipped (SMART) needle in transpopliteal interventions.

The puncture of the popliteal artery for percutaneous intervention is usually performed under fluoroscopic guidance or with the assistance of percutaneous ultrasound to avoid accidental arteriovenous fistulas. We present our experience in 119 cases with the use of a Doppler ultrasound equipped Seldinger needle (SMART needle) for the detection and puncture of the popliteal artery. In 119 interventions in 103 patients, the puncture of the popliteal artery was performed with the SMART needle. The puncture was successful in 94.1% (112 of 119) of cases. Six (5.2%) complications occurred during puncture: four hematomas (no therapy required) and two arteriovenous fistulas (treated by manual compression solely). The subsequent 112 interventions in 103 patients [98 percutaneous transluminal angioplasty (PTA), 8 PTA with stent implantations, 4 PTA with thrombolysis, 2 thrombolyses] were technically successful in 79.5% (89 of 112). The SMART-needle-guided popliteal puncture showed to be safe, fast, and easy to perform, which allowed the use of this technique by radiologists in training. The rates of success and complications are comparable to reported results for other visualization techniques, whereas time, effort, and training required are lower. This may contribute to a more widespread use of the transpopliteal access for interventions and therefore offers a therapeutic option in addition to vascular surgery.

Angioplasty, Balloon↗
PubMed2003

Post-dural puncture headaches in children. A literature review.

UNLABELLED: Post-dural puncture headache (PDPH) is a well recognised complication of spinal and epidural anaesthesia. It can also occur after diagnostic or therapeutic lumbar puncture. Few cases have been reported in children. We reviewed the literature regarding definition, aetiology, incidence, risk factors, prevention and treatment, in order to provide some recommendations. Significant factors include age, gender, needle diameter, needle tip design, orientation of the tip during puncture, previous PDPH, history of migraine and repeated attempts to achieve puncture. There is no evidence for the use of increased fluids or bed rest to prevent PDPH. Once the diagnosis is made, conservative therapy is recommended for 48 h. Persistent PDPH can be treated in several ways; an epidural blood patch is one of the most effective methods. CONCLUSION: occurrence of post-dural puncture headache after lumbar puncture in children is rare. There are conflicting data about risk factors, prevention and treatment.

Anesthesia, Epidural↗
PubMed2006

Limiting vein puncture to three needle passes in subclavian vein catheterization by the infraclavicular approach.

PURPOSE: With central venous catheterization, each additional vein puncture raises the risk of complications. We assessed the rate of failure and complications using a limiting rule whereby the number of needle passes for subclavian vein catheterization was restricted to three. METHODS: A prospective clinical trial was conducted between September 2001 and December 2003 in a university hospital surgical department. Two hundred and thirty-two adult patients were enrolled to undergo subclavian vein catheterization under non-emergency conditions. The patients were subjected to right subclavian vein catheterization by the infraclavicular approach. Vein puncture failure was defined as such if venipuncture was not accomplished after three attempts. Any arterial puncture was judged to be a failure immediately. RESULTS: Vein puncture failure occurred in nine patients (3.9%), and included two arterial punctures (0.9%). No other complications, such as pneumothorax, hemothorax, plexus lesion, mediastinal hematoma or bleeding, or air embolism, were observed. In multivariate analyses, a close to average body mass index (weight in kilograms divided by the square of the height in meters, odds ratio 0.74; 95% confidence interval 0.56-0.97; P = 0.028) was associated with a low risk of failure. CONCLUSION: Limiting the number of needle passes to three may therefore prevent mechanical complications. A low body mass index was predictive of vein puncture failure.

Aged↗
PubMed1995

Fluid characteristics of benign ovarian cysts: correlation with recurrence after puncture.

OBJECTIVE: To determine whether concentrations of gonadal steroids and fibrinolytic indices in fluid from benign ovarian cysts can discriminate between functional and neoplastic cysts and predict recurrence after ultrasound-guided puncture. METHODS: Concentrations of gonadal steroids and components of the plasminogen-activating system were measured in cyst fluid obtained at ultrasound-guided puncture of 96 ovarian cysts and were related to subsequent cyst recurrence. In 83 patients who had surgery for benign ovarian cysts, components of the plasminogen-activating system in the cyst fluid were correlated with the histopathologic diagnosis. RESULTS: Higher levels of plasminogen activators and lower levels of inhibitors were found in those 54 cysts that recurred after puncture and in cysts with low levels (below 2000 pmol/L) of estradiol (E2). This enzyme-inhibitor balance resulted in high fibrinolytic activity. In contrast, cysts with high E2 levels (above 2000 pmol/L) had lower levels of activators, higher levels of inhibitors, and virtually no fibrinolytic activity. A high E2 concentration in cyst fluid was the single best predictor of no recurrence after puncture. Sixteen of 18 cysts in postmenopausal women recurred, and all had low levels of E2. However, an index based on cyst fluid volume and concentrations of E2 and urokinase predicted recurrence even better. A high concentration of urokinase in the fluid correlated with neoplastic histology of the cysts obtained at laparotomy. CONCLUSION: The fluid content of ovarian steroids and plasminogen activators and inhibitors is related to histopathology and recurrence after puncture of benign ovarian cysts. Puncture and assay of these components may minimize surgery on functional cysts.

Estrogens↗
PubMed1991

Subdural hematoma after lumbar puncture: two case reports and review of the literature.

Two cases of intracranial subdural hematoma following lumbar puncture are presented. A review of all previously reported cases shows that subdural hematoma after lumbar puncture is a rare but serious complication. The pathogenesis of subdural hematoma after lumbar puncture is probably related to that of post lumbar puncture headache. Application of an epidural blood patch may therefore be a safe way not only to treat typical post lumbar puncture headache but also to prevent subdural hematoma after lumbar puncture.

Hematoma, Subdural↗
PubMed2005

Efficacy and complications of Angioseal in antegrade puncture.

AIM: Although arterial closure devices are in use for over a decade, there have been no specific study to assess the use of the same in antegrade puncture. MATERIAL AND METHOD: Consecutive patients undergoing antegrade puncture for peripheral vascular disease in a single centre performed by a single operator were included in this study. The notes and the angiograms were reviewed retrospectively for possible complications and the severity of disease. RESULT: Over a 25-month period, 21 patients with antegrade puncture had Angioseal deployed for haemostasis. Post-procedure complications recorded from the case notes showed one episode of haematoma formation and one case of worsening ischaemia. The severity of the disease at the puncture site did not influence the outcome. CONCLUSION: Use of Angioseal is safe and effective in antegrade punctures for peripheral vascular disease. The result is independent of the severity of disease at the puncture site.

Aged↗
PubMed2006

Intra-cardiac echocardiography guided trans-septal puncture in patients with dilated left atrium undergoing percutaneous transvenous mitral commissurotomy.

Percutaneous transvenous mitral commissurotomy (PTMC) is an effective treatment for mitral stenosis, but trans-septal puncture carries a certain risk of complications. There have been few reports on phase-array intra-cardiac echocardiography (ICE) guidance in trans-septal puncture for PTMC, especially in patients with dilated left atrium or distorted anatomy. Herein, we report our preliminary experience with ICE-guided trans-septal puncture in patients with dilated left atrium (>or=5.5 cm) who underwent PTMC. From June 2005 to March 2006, there were nine consecutive patients with symptomatic mitral stenosis and left atrium size larger than 5.5 cm who underwent trans-septal puncture for PTMC with the ICE guidance in this institution by a same operator. The procedural and catheterization results were analyzed. Using ICE guidance, the success rate for trans-septal puncture was 100% for all patients with dilated left atrium (>or=5.5 cm). The trans-septal procedures were free of major and minor complications and the patients were not exposed to contrast medium. Mitral valve area increased significantly from 1.0+/-0.2 cm(2) to 1.9+/-0.2 cm(2). Our preliminary result showed that ICE safely and effectively guided trans-septal puncture for PTMC in patients with dilated left atrium (>or=5.5 cm), thus eliminating contrast medium usage and avoiding unnecessary longer X-ray exposure.

Cardiac Surgical Procedures↗