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PubMed2002

Syndrome of cerebrospinal fluid hypovolemia following lumbar puncture cerebrospinal fluid leak in a patient with idiopathic intracranial hypertension.

An 11-year-old girl presented with headache of 3 months' duration. There was bilateral disc edema. The cerebrospinal fluid pressure was 50 cm of water with normal cerebrospinal fluid cytology and biochemistry. She developed severe headache (different and disabling), dizziness, vomiting, and backache on sitting up 6 hours after lumbar puncture, and lying supine relieved all of her symptoms. Intravenous fluids, analgesics, and complete bed rest did not relieve her symptoms over the next 72 hours. She was completely relieved of her symptoms on receiving two tablets of Caffergot containing 200 mg of caffeine and 2 mg of ergotamine 72 hours after lumbar puncture. The symptoms recurred 48 hours later, and a repeat dose of Caffergot was required. Magnetic resonance imaging (MRI) done 96 hours after lumbar puncture revealed the entire dura overlying the brain, including the posterior fossa, showing intense enhancement on contrast injection with leak at the lumbar puncture site. Oral caffeine (coffee, three times a day) was advised over 1 week. The patient remained asymptomatic, and a repeat MRI scan after 10 days showed complete clearing of the cerebrospinal fluid leak with no dural enhancement. The syndrome of cerebrospinal fluid hypovolemia following lumbar puncture is reported in a girl with idiopathic intracranial hypertension.

Brain↗
PubMed2002

A randomized controlled trial of the effectiveness of topical amethocaine in reducing pain during arterial puncture.

OBJECTIVE: To determine if topical 4% amethocaine gel can reduce the pain associated with arterial punctures. DESIGN: Randomized, placebo-controlled, double-blinded trial with parallel groups. SETTING: Teaching hospital. PATIENTS: Adults requiring arterial punctures for blood gas estimation as part of routine care. INTERVENTIONS: Four percent amethocaine gel applied for 30 min prior to the radial arterial puncture, compared with a placebo gel. MAIN OUTCOME MEASURES: Pain scored on a visual analog scale from 0 to 100, and heart rate during the procedure. RESULTS: The mean pain score for the amethocaine group was 16.0 (SD, 23.3) and for the placebo group was 20.7 (SD, 18.5). The mean heart rates during arterial puncture were 84.1 beats/min (SD, 10.7) for the amethocaine group, and 83.8 beats/min (SD, 12.7) for the placebo group. These differences were not statistically significant. CONCLUSION: The topical use of 4% amethocaine gel does not reduce the pain associated with arterial puncture.

Administration, Topical↗
PubMed2003

Shifting of puncture site in the fossa ovalis during radiofrequency catheter ablation: intracardiac echocardiography-guided transseptal left heart catheterization.

Intracardiac echocardiography (ICE) serves as an adjunct to fluoroscopy for electrophysiological procedures by identifying critical anatomic landmarks and confirming catheter-endocardial contact. In the present study, we investigated the usefulness of ICE for radiofrequency catheter ablation. ICE was utilized to guide transseptal puncture in 19 patients undergoing radiofrequency catheter ablation. The fossa ovalis, which was one critical anatomic landmark, had an average vertical diameter of 18.5 +/- 6.9 mm and an average horizontal diameter of 10.0 +/- 2.4 mm, as measured by ICE and fluoroscopy. Although there was only a small shift of the puncture site in the horizontal direction, the puncture site shifted towards the upper edge of the fossa ovalis for 17 patients (89%). Furthermore, we could verify that the distance between the apex of the tent-shape formed by the pressure of the puncture needle in the fossa ovalis and the left atrial wall opposing it was sufficient to carry out the procedure safely. Confirming the puncture site using ICE is useful in carrying out transseptal left heart catheterization safely.

Atrial Fibrillation↗
PubMed1999

Sequential retroperitoneal venous hemorrhage and embolism of an angio-seal puncture closure device complicating iliac artery angioplasty.

PURPOSE: To present a case of iatrogenic puncture closure device embolization complicating surgery for retroperitoneal hemorrhage (RPH) secondary to angioplasty-induced common iliac vein trauma. METHODS AND RESULTS: A 78-year-old woman with rest pain underwent successful kissing balloon dilation of her aortoiliac bifurcation for a calcified ostial stenosis of the left common iliac artery. Hemostatic puncture closure devices (Angio-Seal) were used to secure both femoral punctures. A right-sided retroperitoneal hematoma developed, and during surgical exploration of the right groin, the Angio-Seal device was removed. The only bleeding site found was the external iliac artery puncture and it was repaired. She again became hypovolemic 18 hours later and was returned to surgery, where bilateral groin explorations and laparotomy by the vascular surgical team found a tear in the left common iliac vein. After repair, the patient was stable for 48 hours when the left leg became critically ischemic. Angiography detected a new high-grade stenosis in the left profunda femoris artery; embolectomy retrieved a footplate from the left puncture closure device. The patient died 11 days later from multiorgan failure. CONCLUSIONS: RPH should be considered early as an occult cause of hypovolemic shock developing soon after even technically straightforward iliac angioplasty. Interventionists should be aware that using the Angio-Seal device risks acute limb ischemia if footplate embolization occurs.

Aged↗
PubMed2004

Pain perception in patients undergoing bone marrow puncture--a pilot study.

The objective of this study was to establish the relationship between the perception of pain, anxiety, and depressive tendency in performance of bone marrow puncture. 93 consecutive patients (62% men, 38% women) from a hematological oncology outpatient department ages 20 to 85 years (M age = 53.7, SD = 15.1) were questioned. On average, the patients had undergone 2.5 (+/- 2.6) punctures. The underlying disease was leukemia in 49%, malignant lymphoma in 41%, another malignant disease in 2%, and there was a benign condition in 8%. Depression and general anxiety were measured using the Hospital Depression and Anxiety Scale (HADS-D). Fear of puncture and perception of pain were registered with visual analog scales. Patients with increased scores of anxiety or depressive tendency on the HADS-D suffered significantly more severely from fear of puncture and pain than patients with normal scores. However, the puncture-related fear in the group as a whole correlated markedly more closely with the intensity and tolerability of pain than did general fear and depressive tendency. This finding must be considered when planning psychological interventions in this group of patients.

Adult↗
PubMed1999

MR imaging with gadolinium in patients with and without post-lumbar puncture headache.

PURPOSE: To study frequency and extent of meningeal enhancement in patients with and without post-lumbar puncture headache (PLPH) with cerebral MR with Gd-DTPA. MATERIAL AND METHODS: Ten consecutive patients with PLPH and 9 consecutive patients without PLPH were included in the study. Nine of the PLPH patients were reinvestigated when the PLPH was over and all non-PLPH patients during the week after the lumbar puncture. RESULTS: Eight of the 9 patients with PLPH showed more enhancement of meningeal structures during PLPH than when PLPH had disappeared. The differences were slight in 5, more marked in 2, and pronounced in 1 patient. The 9th patient showed no change at all. In the 9 patients without PLPH, there was mainly slight enhancement before lumbar puncture and no change in enhancement after lumbar puncture as compared with before. CONCLUSION: PLPH is related to increased Gd-DTPA enhancement of the meninges, although the increase in enhancement during PLPH is minor in most cases. Pronounced enhancement of the meninges after lumbar puncture may predict long duration of the PLPH.

Adult↗
PubMedDate not supplied

[Complications of percutaneous nephrostomy. Apropos of 481 procedures: the value of puncture of the median calices].

The authors report on a series of 481 percutaneous nephrostomy procedures, and describe the complications encountered. 163 percutaneous nephrostomies for drainage and 318 percutaneous stone removals, were performed between 1985 and 1995 in the Radiology Department of Hôtel-Dieu de France Hospital under fluoroscopy. One tract was needed for PN but more than one was sometimes necessary for percutaneous stone removal. Complication rate was identical to the results reported in the literature. Complications were more frequently encountered when the upper calyx was punctured (intercostal approach), mostly pleural lesions. Puncture of the middle and inferior calyx were associated with the same rate of complications, but with different degrees of severity. Major complications (80% of cases of hemorrhage, including all arteriovenous fistulae and pseudoaneurysms) were encountered with the puncture of the lower calyx while those associated with the puncture of the middle calyx were minimal. Thus, puncture of the middle calyx is the least morbid. It is recommended by the authors, whenever possible.

Adolescent↗
PubMedDate not supplied

Sclerotomy using needle puncture and subconjunctival injection of mitomycin C.

OBJECTIVE: To explore the possibilty of creating a temporary sclerotomy using a 26-gauge needle and sustaining its patency by injectiong 0.1 mL of 0.1 mg/mL of mitomycin C (MMC). ANIMALS AND METHODS: Twenty-four New Zealand white rabbits were randomized into 3 groups. In the test group, puncture was performed using 26-gauge needle penetrating the anterior chamber at the limbus, and 0.1 mg/mL MMC were injected subconjunctivally. In the control group, a puncture was performed in the same fashion and in the MMC group, MMC only was injected subconjunctivally. Intraocular pressure (IOP) was measured prior to surgery and at days 1, 3, 7, 10, 14, 21, and 28. RESULTS: The mean intraocular pressure in eyes that underwent puncture with application of MMC was significantly lower than the IOP in the eye at all measurements up to and including day 21. In the puncture group, pressure was significantly lower than in the fellow eye only at day 3. No significant pressure reduction was observed at any measurement interval in eyes treated with MMC only. CONCLUSION: This simple technique of subconjunctival puncture of the limbus combined with application of MMC was effective in lowering IOP in rabbits. This may serve to attain a temporary filter in patients who need strict short-term pressure control.

Animals↗
PubMed2003

[Research of the puncture depth in treatment of trigeminal neuralgia (TN) by radiofrequency thermocoagulation(RFT) under CT location].

OBJECTIVE: To control the puncture depth properly and avoid the complications, CT scan was used to measure the depth as the puncture needle perforated through the foramen ovale. METHODS: Analysis of the CT scan diagrams of 121 cases suffering from TN cured by RFT, and measuring the puncture depth. RESULTS: The average puncture depth was 0.88 cm, the maximum was 1.6 cm, and the minimum was 0.4 cm. CONCLUSION: The puncture depth can be manipulated correctly by CT location, the second and third branches can be avoided to be damaged within 0.8 cm, and the first branch can be avoided to be injured between 1.2 cm and 1.5 cm.

Adult↗
PubMed1992

[Appropriate puncture site for CT monitored celiac plexus block determined from CT films].

We investigated appropriate puncture site, angle of needle entry, and the distance of the insertion for CT monitored celiac plexus block using CT photograms on prone position in sixteen patients with gastrointestinal diseases. In retrocrural approach during CT monitored celiac plexus block, the average distances of puncture sites to midline were 3.84 cm on the right and 4.06 cm on the left, and the average needle angles were 74.1 degrees on the right and 76.9 degrees on the left. The average depths from the puncture site to marked position in retrocrural space were 7.88 cm on the right and 7.85 cm on the left. The rates of predicted organ puncture when needle is inserted 7 cm lateral to the midline of the spinal process were 43.8 percent in the right lung, 12.5 percent in the left lung, 56.2 percent in the right kidney and 68.8 percent in the left kidney. From these results, we found high possibilities of organ injuries using the conventional technique for celiac plexus block. We conclude that we could perform celiac plexus block more safely and surely using the retrocrural approach by CT monitoring, as serious complications are avoidable by viewing ideal puncture course on CT photographs.

Aged↗
PubMedDate not supplied

[Lowered incidence of post-lumbar puncture headache following the application of the second edition of the International Headache Society classification].

INTRODUCTION: In 1988 the International Headache Society (IHS) published the 1st edition of its headache classification and the 2nd edition was completed in 2003. AIM. To determine whether there exist changes in the incidence of post-lumbar puncture headache depending on the edition of the IHS classification. PATIENTS AND METHODS: Between 2002 and 2003 data was gathered prospectively for 78 patients who were submitted to a diagnostic lumbar puncture, 40 obstetric spinal anaesthesias and 516 non-obstetric spinal anaesthesias. The 1st edition was used and, after the appearance of the 2nd edition, the cases were recoded. RESULTS: With the 1st edition, there were 31 out of 78 cases (39.7%) of post-puncture headache in diagnostic punctures, and when the 2nd edition was used, the number dropped to 10 cases (12.8%). The incidence of headache among patients who had undergone obstetric spinal anaesthesia was six cases out of a total of 40 (15%) using the 1st edition, and four cases with the 2nd edition (10%). The incidence of headache among patients after non-obstetric spinal anaesthesia was 80 cases out of a total of 516 (15.5%) when the 1st edition was utilised and 25 cases with the 2nd edition (4.85%). CONCLUSIONS: To compare the incidences of post-lumbar puncture headaches obtained by diverse observers we need to know which edition was used, since there are considerable differences between the results obtained using one edition or the other. The main reason accounting for the discrepancy between the two editions is the compulsory association of some accompanying sign, since this was not a necessary criterion in the 1st edition but it is included in the 2nd.

Adolescent↗
PubMed1992

Experimental transjugular portacaval shunt. Use of a fine-needle puncture device for the implantation of Strecker stents.

A transjugular portacaval intrahepatic stented shunt was created in 16 pigs without induced portal hypertension. A fine needle (OD 0.7 mm) was used for the transjugular puncture of the portal vein. The puncture was done directly from the inferior vena cava in 5 cases and from the right liver vein in 11 cases. The puncture tract was dilated and subsequently supported by a Strecker stent. The stented shunt was patent in all cases immediately after the stent placement, but was obstructed by fibrous tissue in 7 of 8 cases reexamined by angiography and autopsy after 4 weeks. Complications seem to be related to the choice of the puncture site, with fewer complications when the puncture was done via the right hepatic vein.

Animals↗
PubMedDate not supplied

Continuous spinal anesthesia after unintentional dural puncture in parturients.

Headache after unintentional dural puncture with 17- or 18-gauge needles represents a significant source of anesthetic-induced maternal morbidity. We performed this study to determine whether inserting a catheter into the subarachnoid space after dural puncture can significantly alter the incidence of headache. Thirty-five women, requesting labor analgesia, suffered a dural puncture during attempts to identify the epidural space using an 18-gauge Hustead needle (bevel oriented parallel to the longitudinal axis of the back). Subsequently, the anesthesiologist inserted a 20-gauge polyamide catheter into the CSF and provided continuous spinal anesthesia throughout labor and delivery. A second group of 21 women suffered dural puncture with the same epidural technique but without subarachnoid catheter insertion. These women subsequently received lumbar epidural anesthesia. After delivery, we visited all women daily until discharge and questioned them about the presence and severity of headache. Neither the incidence of headache nor the need for therapeutic blood patch differed significantly between the two groups of women. No other anesthetic related complications ensued. Continuous spinal anesthesia after unintentional dural puncture does not decrease the incidence of headache in parturients.

Analgesia, Obstetrical↗
PubMed1988

Skin-puncture and blood-collecting technique for infants: update and problems.

This is updated information on acceptable practice in skin puncture and blood collection in infants, as well as on the devices used, with the additional aim of emphasizing major problem areas and some tentative solutions. Consensus standards for skin puncture have little experimental support, and evade the hard fact that studies are needed to clarify optimum sites for puncture and depth and width of lancets, and to assess the effects of compression and skin resistance in the puncturing process. Preliminary data revealed that the puncturing depth of 2.4 mm recommended for the newborn is excessive. In four of 14 newborns at necropsy, the distance from posterior planar skin surface to underlying bone ranged between 2.0 and 2.2 mm. An experimental lancet, with a 1.8-mm tip length and a diameter of 0.79 mm yielded customary blood volumes from newborns in three of the four pediatric centers where it was tested. Lack of success with the lancet was attributed to inexperienced phlebotomists, not to the lancet's decreased size. Also reviewed are problems with common devices used, and the need for examining the "economy" of blood collection.

Blood Gas Analysis↗
PubMed1986

Primary tracheo-esophageal puncture voice restoration with laryngectomy.

In 1979 Singer and Blom introduced a technique of tracheo-esophageal puncture for restoration of voice in the post-laryngectomy patient. This procedure is usually done as a staged secondary procedure, six months after the primary laryngectomy. This study compares 13 patients who have had a laryngectomy and primary tracheo-esophageal fistula formation with 13 patients in whom the procedure is performed as a delayed operation. A clinical evaluation of the results of tracheo-esophageal puncture is presented. Acceptable results were obtained in 77% of the primary tracheo-esophageal puncture group whereas only 54% of the delayed group attained acceptable results. The advantages of primary tracheo-esophageal puncture include an improved patient morale and acceptance of the procedure, as well as the ability to feed the patient through the Foley catheter. The disadvantages of performing the procedure primarily include an increased rate of postoperative mucocutaneous fistula. The relationship of the tracheo-esophageal puncture to the increased fistulization rate is discussed. Further experience is required before firm conclusions can be drawn about the role this procedure will take in the management of patients for cancer of the larynx.

Aged↗
PubMed1977

[Suprapubic puncture of the bladder within the scope of bacteriological urine diagnosis in gynecological-obstetrical patients].

Technology, evidence as well as indications and contraindications of the suprapubic bladder puncture are shown from a gynecological and obstetrical point of view. The bacteriological result of urine obtained by puncture from 476 women has been compared with that obtained subsequently by midstream voiding. It was proved statistically that bladder puncture yielded less positive results than midstream voiding. In 8.4 per cent of the cases there was a positive voided midstream urine culture with pathogenic bacteria while the samples of bladder puncture were sterile, thus 29.2 per cent of the positive voided midstream urine cultures proving to be "false-positive" concerning an infection of the bladder and of the upper urinary tract. The frequency of pathogenic bacteria, "apathogenic" bacteria and mixed cultures is given, divided into conforming and nonconforming culture results of puncture and midstream urines.

Bacteriuria↗
PubMed1994

Post-dural puncture headache: a comparison of the Sprotte and Yale needles in urological surgery.

One hundred elderly male patients undergoing transurethral surgery were allocated randomly to receive spinal anaesthesia with either a 26 gauge Yale needle or a 24 gauge Sprotte needle. Patients were visited within 48 h by an investigator who was unaware of the needle type used and specific enquiry was made about any headache which was characteristic of dural puncture. We found evidence of a postdural puncture headache in 15 (30%) patients in whom a 26 gauge Yale needle was used. By comparison, only three patients (6%) in the Sprotte group reported a postdural puncture headache. This represents a highly significant (P < 0.005) reduction in the incidence of postdural puncture headache. The incidence of multiple attempts at dural puncture was also significantly (P < 0.05) reduced to 16% in the Sprotte group compared with 28% in the Yale group.

Aged↗
PubMed1994

Frequency of unexplained meningeal enhancement in the brain after lumbar puncture.

PURPOSE: To examine the hypothesis that lumbar puncture alone may cause meningeal enhancement in the brain. METHODS: We prospectively reviewed the brain MR examinations of all patients from a 6-month period who were studied within 1 month after lumbar puncture. We also retrospectively reviewed all cases of dural-arachnoidal enhancement in the brain from the preceding 18-month period. RESULTS: In the prospective group, only one case out of 97 enhanced brain MR examinations after lumbar puncture did not have a clear cause for dural-arachnoidal enhancement. In the retrospective group, only one case out of 11 with enhancement was not clearly explained. CONCLUSIONS: Dural-arachnoidal enhancement in the brain after lumbar puncture is uncommon, if it occurs at all, and lumbar puncture as a cause of enhancement should be considered a rare diagnosis of exclusion.

Adult↗