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At least 307 records · Page 17Linked to original sources
PubMed1995

[Less headache following lumbar puncture with the use of an atraumatic needle; double-blind randomized study].

OBJECTIVE: To investigate the difference in frequency of headache after lumbar puncture with a standard needle or an atraumatic needle. DESIGN: Prospective, randomised double blind study. SETTING: Department of Neurology, Merwedeziekenhuis, Dordrecht. METHOD: One hundred sequential patients were randomised to lumbar puncture with a 'standard needle' (20 gauge) or an 'atraumatic needle' (pencil point, 22 gauge). The patients were interviewed one week later. Patient and interviewer were unaware of the needle used. RESULTS: After puncture with the standard needle 32% of the patients suffered from postlumbar puncture headache, after use of the atraumatic needle 6% (p < 0.001; 95% confidence interval of the difference: 0.11-0.40). Postpuncture complaints appeared to be less severe after puncture with the atraumatic needle. CONCLUSION: In comparison with a standard needle, there is significantly less postpuncture headache after lumbar puncture with an atraumatic needle.

Adolescent↗
PubMed1995

[Usefulness of intracardiac echocardiography for guidance of transseptal puncture procedure].

The clinical usefulness of intracardiac echocardiography (ICE) for the guidance of transseptal puncture procedure during percutaneous left heart bypass support (PLHBS) and percutaneous transvenous mitral commissurotomy (PTMC) was investigated to replace intraoperative transesophageal echocardiography monitoring which requires mild sedation and causes patient discomfort. The ICE procedure was assessed in 3 patients with PLHBS and 18 with PTMC using a 10 MHz rotating 8 French probe system especially developed for the purpose. Transseptal puncture procedure was observed by intraoperative ICE monitoring in the right atrium. The ICE images showed the transseptal puncture (Brokenbrough) needle as a point casting an acoustic shadow. By moving the ICE probe up and down, the excursion of the needle and its approach to the septal wall could be clearly observed. If the puncture needle is forced into the intra-atrial septum, the septal wall was clearly observed to protrude into the left atrium (tent-formation). In a tent-formation the puncture site could be determined by ICE alone. Intracardiac echocardiography guidance was useful and may improve the safety and reliability of the transseptal puncture procedure in PLHBS and PTMC.

Adult↗
PubMed1994

Percutaneous puncture of the external carotid artery or its branches after surgical ligation.

PURPOSE: To describe the technique and results of percutaneous puncture of the external carotid artery or one of its branches distal to a surgical arterial ligation. METHODS: Forty-three patients underwent 64 embolization attempts by percutaneous arterial puncture distal to an external carotid artery ligation. The punctured arteries were the trunk of the external carotid artery in 31 patients, the internal maxillary artery in nine, the facial artery in nine, the lingual artery in eight, the occipital artery in four, and the superficial temporal artery in three. RESULTS: In 64 attempts 57 were successful in one session, six were successful in two sessions, and one failed. Puncture-related complications were eight spontaneously resolving hematomas and six asymptomatic punctures of the internal carotid artery. CONCLUSION: After surgical ligation of the external carotid artery or its branches, arterial puncture above the ligation allowed selective catheterization and endovascular occlusion of vascular lesions.

Adolescent↗
PubMed1993

Computed tomography before lumbar puncture in acute meningitis: a review of the risks and benefits.

OBJECTIVE: To determine the indications, if any, for routine computed tomography (CT) of the brain before lumbar puncture in the management of acute meningitis. DATA SOURCES: Original research papers, reviews and editorials published in English from 1965 to 1991 were retrieved from MEDLINE. The bibliographies of these articles and of numerous standard texts were examined for pertinent references. A survey of local neurologists was conducted, and legal opinion was sought from the Canadian Medical Protective Association. DATA EXTRACTION: There were no studies directly assessing the risks of lumbar puncture in meningitis; however, all sources were culled for other pertinent information. RESULTS: No cases could be found of patients with acute meningitis deteriorating as a result of lumbar puncture. The neurologic consensus refuted the need for CT in typical acute meningitis. All sources stressed speedy lumbar puncture and the early institution of appropriate antibiotic therapy to minimize the severity of the illness and the risk of death. CONCLUSIONS: (a) There is no evidence to recommend CT of the brain before lumbar puncture in acute meningitis unless the patient shows atypical features, (b) for patients with papilledema the risks associated with lumbar puncture are 10 to 20 times lower than the risks associated with acute bacterial meningitis alone, (c) CT may be necessary if there is no prompt response to therapy for meningitis or if complications are suspected, (d) the inability to visualize the optic fundi because of cataracts or senile miosis is not an indication for CT and (e) there are no Canadian legal precedents suggesting liability if physicians fail to perform CT in cases of meningitis.

Acute Disease↗
PubMed1993

[Experience in the use of central venous catheterization via subclavian puncture in a pediatric hospital].

OBJECTIVE: To assess the frequency and type of complications during central venous catheter installation by subclavian puncture, and during its use in children admitted to an ICU. PATIENTS AND METHODS: Patients from one month to 15 years of age, admitted to the Intensive Care Unit of the Hospital de Pediatría Centro Médico Nacional, Siglo XXI, who underwent a percutaneous infraclavicular subclavian puncture for central venous catheter complications were included. Clinical features, diagnosis, complications and indications for the procedure were registered. RESULTS: 92 patients and 102 subclavian punctures were included for analysis. Effectively index was 88.3%. Main diagnosis was infectious diseases in 29.4% and neoplasia in 22.5%. Hemodynamic monitoring was the more frequent indication for the procedure (44%). Of the catheter 45% were successfully installed at first intent. The complication in the installation appear in 11.7%. Was arterial subclavian puncture (6.8%), hematoma (2.9%), without hemodynamic deterioration no any case. The mean time of permanence was 8.8 days. The late complications was present in average 7.3 days, in 18.6% of the cases. Predominance infection in entrance place of catheter. CONCLUSIONS: Installation of venous central catheter by subclavian puncture prove a great utility in our patients, with a few complications and a high effectively. For experimental personal the central venous catheterization by subclavian puncture in pediatric patients to be importance in the first place in critical ill children.

Adolescent↗
PubMed1997

[The changes of regional cerebral blood flow and oxygen metabolism following ventricular puncture].

In seven patients who underwent ventricular puncture as a procedure for either continuous ventricular drainage or ventriculoperitoneal shunt between April 1983 and December 1988, the changes between pre- and postoperative regional cerebral blood flow (rCFB) and the regional cerebral metabolic rate of oxygen (rCMRO2) around the regions along the tract of puncture were evaluated. In each patients, rCBF and rCMRO2 were measured using Positron Emission Tomography (PET) by the steady state method. The regions of interest (ROIs) with diameters of 2cm were set as follows: The gray matter (PSG) and white matter (PSW) along the tract of the puncture, the same regions on the opposite side (OSG and OSW) and the bilateral motor cortex (PSM and OSM) as control. All changes, as well as lateralities at each region were studied. In 4 of 7 patients long term follow up PET studies (mean = 657 days after the procedure) were performed. After the procedure values of rCBF significantly increased in OSG and OSW (p < 0.05) and tended to increase in PSG and PSW. But compared with OSG and OSW, the degree of increase in PSG and PSW were suppressed. In the motor cortex evident changes were not recognized. Lateralities between PSG and OSG and those between PSW and OSW tended to increase after procedure. In long term follow up studies the values further increased in all regions including PSG and PSW and lateralities tended to decrease, but suppression of improvement around the puncture site was prolonged. The changes of rCMRO2 had the same tendency but it was not significant. The rCBF and rCMRO2 generally increased following the procedure accompanying ventricular puncture. Perhaps this was because of adjustment of increased intracranial pressure or cerebrospinal fluid circulation. But the degree of improvement around the puncture site was suppressed. Minor brain injury caused by the procedure was considered to be the cause of reduction of improvement of cerebral blood flow and cerebral oxygen metabolism.

Aged↗
PubMed1997

[Medical treatment of venous priapism apropos of 46 cases: puncture, pharmacologic detumescence or penile cooling?].

OBJECTIVE: To analyse the efficacy of three nonspecific medical approaches to the first-line treatment of priapism : a) intracavernous injection (ICI) of alpha-adrenergic agonists, b) cavernous puncture, c) penile cutaneous cooling. METHODS: 46 cases of venous priapism, due to various aetiologies, were initially treated by ICI of alpha-adrenergic agonists (23 cases), puncture (14 cases) or cooling (9 cases). These 3 methods were combined only in the case of failure and not uniformly, based on our experience. The results were analysed in terms of successful detumescence and preservation of erectile function. RESULTS: Detumescence was obtained and erectile function was preserved in almost 80% of cases, with conservative treatment alone. ICI (83%) and cooling (78%) were more effective as first-line treatment than puncture (57%). The delay to treatment was a more important parameter than the aetiology. Cooling was no longer effective after the 8th hour, puncture was no longer effective after the 9th hour and ICI was no longer effective after the 34th hour. Failures of conservative treatment and erectile sequelae were only observed in cases of priapism treated after the 24th hour. CONCLUSION: The 3 methods have a similar degree of efficacy, provided they are performed early. Their indication depends on : 1) the duration of priapism, 2) the presence or absence of cavernosal anoxia. Schematically (and in parallel with aetiological treatment when possible) : a) in the case of painless priapism < 12 hours, cooling can be tried first, b) in the case of failure or painless priapism > 12, but < 24 hours, ICI of alpha-adrenergic agonists associated with puncture is indicated (except in the case of contraindications to ICI), c) in the case of painful priapism or > 24 hours, puncture must be the first treatment. In the case of failure, cavernosal blood gases should be performed to evaluate cavernosal anoxia and to guide management.

Adrenergic alpha-Agonists↗
PubMed1994

Evaluation of transvaginal ultrasound-guided follicle puncture to collect oocytes and follicular fluids at consecutive times relative to the preovulatory LH surge in eCG/PG-treated cows.

Holstein-Friesian cows (n=56) were synchronized with Syncro-Mate B, and those cows (n=47) developing a normal progesterone pattern were further treated im with 3,000 I.U. eCG at Day 10 and 22.5 mg PGF2alpha 48 h later. Blood samples were collected every hour from 30 until 49 h after PG administration. Cows (n=17, 36.2%) with fewer than 8 follicles larger than 8 mm in diameter at 28 to 30 h after PG treatment and animals without an LH peak (n=7, 23%) were excluded from the study. Transvaginal ultrasound-guided puncture of the follicles was carried out two times per cow, at 30 h after PG injection (4 to 5 follicles) and again at 1 to 5 (n=6), 12 (n=8) or 22 h (n=9) after the LH peak. No differences in the concentrations of progesterone and LH were observed among the 3 groups. An average of 18 follicles per cow was punctured (total of 415 punctures, n=23); 116 cumulus-oocyte-complexes and 370 follicular fluid samples were obtained producing average recovery rates of 28.0% and 89.2%. The number of cumulus-oocyte-complexes varied between puncture times; shortly before ovulation, at 22 h after the LH peak, the recovery rate was significantly 5 times higher than immediately after the LH peak. Overall, in 75 punctures the cumulus-oocyte-complex was accompanied by a pure follicular fluid sample (3.3 per cow). In conclusion, the transvaginal ultrasound-guided puncture of preovulatory-size follicles can be used to collect follicular fluids to study changes in the microenvironment of maturing oocytes upon superovulation. However, further research is required in order to obtain an equivalent number of accompanying cumulus-oocyte-complexes.

Journal Article↗
PubMedDate not supplied

Procedure and principles in ultrasonically guided puncture.

It is the aim in ultrasonically guided puncture to place the tip of an appropriate needle safely and accurately in the suspect lesion or organ, vessel or duct. Thereby representative specimens of fluid or solid tissue are obtained, various agents, e.g. X-ray contrast media may be injected or catheters left for drainage. Simultaneous visualization of the target, the surrounding tissues, part of the needle and its tract has become possible with dynamic scanners of different types. The adjunct of needle steering devices significantly reduces the number of puncture attempts and in most cases the puncture route can be pre-determined precisely, so that readjustment of the puncture direction is unnecessary, unless puncture of different sites in the target is directly intended. The practical performances of such punctures are described together with the necessary equipment and remedies.

Biopsy, Needle↗
PubMed1993

An assessment of the incidence of punctures in gloves when worn for routine operative procedures.

The value of glove wearing as part of dental surgery cross-infection control regimen is negated if gloves are punctured during use. An assessment of the procedures most likely to give rise to glove puncture is therefore of importance. Accordingly, 892 gloves worn by two dentists in general practice were examined for punctures, after being used in one of seven common operative procedures. It was found that gloves used for the treatment procedures investigated had a significantly higher proportion of punctures than unused gloves of the same type. Gloves used for surgical extraction showed the highest proportion punctured (16%). There was no significant difference in puncture frequency between the gloves worn on left or right hands irrespective of procedure.

Crowns↗
PubMed2003

The role of ultrasonographically guided puncture of the human rete testis in the therapeutic management of nonobstructive azoospermia.

We attempted to characterize the cells collected from the rete testis via ultrasonographically guided puncture. Unilateral puncture of the rete testis was performed in nine men with obstructive azoospermia and 51 men with nonobstructive azoospermia. All the aspirated samples from the rete testis were observed via confocal scanning laser microscope and some of them after fluorescent in situ hybridization techniques. Then therapeutic testicular biopsy was performed in the punctured testis of each man. Spermatozoa were found in all rete testis samples and all biopsy samples from obstructed men. Twenty-two nonobstructed men demonstrated absence of spermatozoa in biopsy samples. Twenty-nine nonobstructed men showed spermatozoa in biopsy material and 24 of these men (82%) had demonstrated spermatozoa in rete testis samples. There were no significant differences in fertilization and cleavage rate between intracytoplasmic sperm injection trials using biopsy spermatozoa and rete testis spermatozoa both in obstructed and nonobstructed men. Considering that puncture of the rete testis does not reduce the volume of testicular parenchyma, is less invasive and apparently causes less detrimental effect on testicular vasculature than biopsy, puncture of rete testis is recommended as first line approach for the treatment of azoospermic men. If puncture is negative for spermatozoa in nonobstructed men, biopsy is indicated.

Biopsy↗
PubMed1989

Effect of transuterine puncture during transvaginal oocyte retrieval on the results of human in-vitro fertilization.

In many in-vitro fertilization (IVF) programmes, the transvaginal approach is now the most widely used method for ultrasound-guided oocyte retrieval. Sometimes, however, the position of the ovaries is such that it might not be possible to aspirate the follicle transvaginally without puncturing the uterine wall. Between May and November 1988, we performed 518 transvaginal, ultrasound-guided oocyte retrievals for IVF or zygote intra-Fallopian transfer (ZIFT). During this period, 22 transuterine punctures (4.2%) were necessary to reach one of the ovaries. To investigate the effect of uterine laceration on the results of IVF/ZIFT treatment, the outcome of treatment was compared between patients who had a transuterine puncture and a control group of patients treated by IVF or ZIFT during the same period without transuterine puncture. Seven of 16 patients who had a transuterine puncture became pregnant after IVF, compared to 84 pregnancies out of 347 cases (24.2%) in the control group. After ZIFT, two pregnancies (2/6) were achieved in patients with uterine laceration, compared to 46 pregnancies out of 149 procedures (30.8%) in the control group. These differences were not statistically significant. Transuterine puncture during transvaginal oocyte retrieval does not seem to have an adverse effect on the results of human IVF and ZIFT treatment.

Female↗
PubMed1989

Anatomic evaluation of cisternal puncture.

Cisternal puncture, although less frequently used since the advent of computed tomography and magnetic resonance imaging, is an important tool in the neurodiagnostic armamentarium. An anatomic study of cisternal puncture was conducted on fresh cadavers by direct visualization and fluoroscopic guidance of cisternal puncture. Anatomic and radiographic analyses demonstrated a dramatic dynamic anatomy of the cisternal space during cisternal puncture and indicated that "tenting" of the dura mater over the needle occurs reliably during cisternal puncture. Lateral fluoroscopy may decrease the risk of cisternal puncture by allowing visualization of needle depth in the cisternal space.

Cerebrospinal Fluid Shunts↗
PubMed2005

A novel rabbit model of mild, reproducible disc degeneration by an anulus needle puncture: correlation between the degree of disc injury and radiological and histological appearances of disc degeneration.

STUDY DESIGN: An in vivo study to radiographically and histologically assess a new method of induction of disc degeneration. OBJECTIVE.: To establish a reproducible rabbit model of disc degeneration by puncturing the anulus with needles of defined gauges and to compare it to the classic stab model. SUMMARY OF BACKGROUND DATA: New treatment approaches to disc degeneration are of great interest. Although animal models for disc degenerative disease exist, the quantitative measurement of disease progression remains difficult. A reproducible, progressive disc degeneration model, which can be induced in a reasonable time frame, is essential for development of new therapeutic interventions. METHODS: The classic anular stab model and the new needle puncture model were used in the rabbit. For the needle puncture model, 3 different gauges of needle (16G, 18G, and 21G) were used to induce an injury to the disc to a depth of 5 mm. Radiographic and histologic analyses were performed; magnetic resonance images were also assessed in the needle puncture model. RESULTS: Significant disc space narrowing was observed as early as 2 weeks after stabbing in the classic stab model; there was no further narrowing of the disc space. In the needle puncture model, all needle sizes tested induced a slower and more progressive decrease in disc height than in the classic stab model. The magnetic resonance imaging supported the results of disc height data. CONCLUSIONS: The needle puncture approach, using 16G to 21G needles, resulted in a reproducible decrease of disc height and magnetic resonance imaging grade. The ease of the procedure and transfer of the methodology will benefit researchers studying disc degeneration.

Animals↗
PubMed2005

The management of accidental dural puncture during labour epidural analgesia: a survey of UK practice.

The management of accidental dural puncture and postdural puncture headache in obstetric practice continues to be of great interest. This survey aims to explore the current management of this complication in the United Kingdom and compares the findings to a similar survey undertaken in 1993. A postal questionnaire was sent to all maternity units (n = 248). The return rate was 71%. Of these, 144 units (85%) now have written guidelines for the management of accidental dural puncture compared to 58% in 1993. In 47 units (28%), the epidural catheter is now routinely placed intrathecally following accidental dural puncture; in 69 units (41%) the catheter is re-sited and in the remaining 53 units (31%) either option is allowed. This is in contrast to the previous survey, which found that catheters were re-sited in 99% of units. Only 31 units (18%) now limit the second stage of labour and 19 (11%) avoid pushing and deliver by ventouse or forceps, whilst 116 units (69%) allow labour to take place without any intervention. Only 44 units (26%) now treat postdural puncture headache with an epidural blood patch as soon as it is diagnosed, whereas in 120 units (71%) the blood patch is performed only after failure of conservative measures. Due to the large increase in the use of the intrathecal catheter following this complication, a follow-up questionnaire was posted 5 months later to those units (n = 99) that reported this practice in the initial survey, with a 94% response rate. The two most commonly cited reasons for intrathecal catheterisation were to avoid further dural puncture (76%) and to allow immediate analgesia for labour (75%).

Analgesia, Epidural↗
PubMed1995

Transthoracic needle biopsy of thoracic tumours by a colour Doppler ultrasound puncture guiding device.

BACKGROUND: Ultrasound guided transthoracic needle aspiration biopsy has recently been used to obtain specimens for histological diagnosis of pulmonary and mediastinal tumours. Conventional real time, grey scale puncture guiding devices cannot differentiate vascular structures, and clear visualisation of the needle shaft or tip within a desired target is not always possible. This study describes a new built-in colour Doppler ultrasound puncture guiding device and assesses the relative safety of transthoracic needle aspiration biopsy of thoracic tumours by grey scale or colour Doppler ultrasound guidance. METHODS: Thirty patients with radiographic evidence of pulmonary (22 patients) or mediastinal tumours (eight patients) underwent ultrasonographic evaluation and transthoracic needle aspiration biopsy by using the colour Doppler ultrasound puncture guiding device (Aloka UST 5045P-3.5). These tumours were initially examined by grey scale ultrasound, and colour Doppler imaging was then used to evaluate the number of blood vessels surrounding and within the target tumour and the possibility of visualisation of the needle shaft or needle tip during the aspiration biopsy procedure. RESULTS: The colour Doppler ultrasound guiding device was far superior to the grey scale device for identification of the number of vessels surrounding or within the target tumour (83% v 20%) and for visualisation of the needle shaft or needle tip (80% v 17%). CONCLUSIONS: By using the colour Doppler ultrasound puncture device, vascular structures surrounding or within the target tumour can be verified. Visualisation of the needle shaft or tip is also better. Biopsy routes can be selected to avoid puncturing vessels. This approach should be particularly helpful for guiding biopsies of mediastinal tumours, where puncturing the heart or great vessels is a potential complication.

Adult↗
PubMed1988

Single arterial puncture vs arterial cannula for arterial gas analysis after exercise. Change in arterial oxygen tension over time.

In an attempt to find the least invasive, safest, easiest, and cheapest method of obtaining resting and exercise samples of arterial blood, a comparison was made between samples from an arterial needle puncture and an arterial cannula. This study demonstrated that samples of arterial blood may be obtained by radial arterial puncture both at rest and during exercise in practically all cases without morbidity. Samples from arterial needle puncture provide the same results as those from arterial cannulas. In the very rare patient in whom arterial puncture during maximal exercise is unsuccessful, the arterial oxygen pressure (PaO2) measured at 10 seconds after exercise correlates very well with the PaO2 at maximal exercise, and the 15-second value correlates nearly as well. Arterial cannulas are needed in the infrequent case when arterial puncture is not accomplished during maximal exercise and the 10-second or 15-second PaO2 decreases from the resting value. In this instance, determination of the exact extent of the hypoxemia requires an exercise sample obtained by cannula; however, the decrease in PaO2 obtained by arterial needle puncture at 10 or 15 seconds will be all that is needed many times to make a clinical decision. Values obtained at 20 seconds after maximal exercise reflect less of the exercise measurement and cannot be used; however, all episodes of significant hypoxemia (PaO2 less than 60 mm Hg) were captured by the analysis at 20 seconds after exercise.

Adult↗
PubMed1996

Comparison of newborn circumcision pain to calcaneal heel puncture pain: is newborn circumcision pain control clinically warranted?

In newborns, elective male circumcision and calcaneal puncture for obtaining blood samples both cause pain. With elective male circumcision, dorsal penile nerve block (DPNB) is recommended for pain control, but no pain control is routinely recommended or used during calcaneal puncture. A prospective investigation was conducted to compare pain during elective circumcision (with and without DPNB) and calcaneal puncture to determine whether pain control should be used with the latter procedure. The study was conducted at a community hospital during a 4-month period. Two nurses observed newborn behavior during elective circumcision and routine calcaneal puncture and rated pain reactions by using a modified Gronigen Distress Scale. Ninety-one male newborns were circumcised without DPNB, and eight male newborns were circumcised with DPNB. Calcaneal puncture for blood samples was performed in 97 newborns (males and females). Pain scores during circumcision with and without DPNB were comparable with those during calcaneal puncture (2.1, 2.4, and 2.2, respectively). Pain control during circumcision may thus be considered, but caution should be taken that measures to prevent pain do not create new patient risk or additional pain.

Blood Specimen Collection↗