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PubMed1994

Endosonographically guided fine-needle aspiration puncture of paraesophagogastric mass lesions: preliminary results.

Mass lesions adjacent to the gastroesophageal wall can be visualized in detail by endoscopic ultrasonography. However, in many patients tissue diagnosis of these mass lesions is urgently required. We evaluated the efficiency of transmural fine-needle aspiration puncture guided by endosonography for cytological confirmation of such mass lesions. Endosonographically guided transmural fine-needle aspiration (EUS-guided FNA) puncture was performed in 12 patients with extrinsic mass lesions adjacent to the gastro-esophageal wall. In seven patients a malignant tumor and in four patients a benign lesion, were identified by EUS-guided FNA puncture, while in one patient no diagnostic tissue specimen could be obtained. No complications were observed. The cytological result of a malignant lesion was confirmed in six patients either by autopsy (n = 3), resection of tumor metastasis (n = 1) or by demonstration of a local recurrence of a previously histopathologically diagnosed carcinoma (n = 2), while the benign cytological results in four patients were confirmed by a follow-up period of at least 13 months (n = 3) and appropriate diagnostic tests (n = 1). It is concluded that EUS-guided FNA puncture is an efficient diagnostic technique for the assessment of malignancy and tissue diagnosis of extrinsic paragastroesophageal mass lesions. An important precondition for the successful performance of transmural EUS-guided FNA puncture is the application of endosonographic transducers with longitudinal scanning in the axis of the endoscope.

Aged↗
PubMed1986

[Ultrasound controlled follicle puncture in the "2 instrument technic"].

The authors present a new instrumentarium for ultrasonically guided transabdominal-transvesical follicular puncture. Permanent sonographic imaging of the puncture cannula and precise puncturing without being impeded by the resistance of the abdominal wall are provided by an attachment functioning as an adjustable target device developed for the soundhead of the sector scanner DIASONICS DS 1 and by introduction of a trocar with a puncture cannula sliding within the trocar at low resistance ("two-instruments technique"). In 12 women, 47 follicles were punctured, 30 human oocytes were collected, 12 embryos transferred and two pregnancies achieved after in vitro fertilisation (twins in one woman, a single child in another).

Embryo Transfer↗
PubMed1984

[Failure of puncture sonographic diagnosis of focal liver lesions--the influence of possible sources of error].

A correct diagnosis was obtained in 92 cases (87.6%) of 105 sonographically monitored fine-needle punctures of focal lesions of the liver; in 13 cases (12.4%) the diagnosis was wrong. Both groups were compared with each other in respect of the anatomic and sonographic properties of the puncture targets and the technique of biopsy employed. Reflexibility and definability of the lesions did not influence the number of wrong diagnoses in puncture sonography; likewise, the following factors did not affect the quota of errors: the macroscopic structure of the punctate; the outer diameter of the fine needle; and the fact whether puncture was effected by means of a special biopsy sound head or by free-hand technique. Limited influence was exercised by the size and depth position of the intrahepatic space-occupying growths and by the number of punctures.

Biopsy, Needle↗
PubMed2001

Subdural haematoma after dural puncture headache treated by epidural blood patch.

Subdural haematoma is a well-documented complication of accidental dural puncture, and is thought to be preventable by prompt treatment with an epidural blood patch. An accidental dural puncture occurred in a 39-yr-old primagravida during the siting of an epidural catheter for pain relief in labour. Twenty hours after the puncture, the mother developed a typical postdural puncture headache, which increased in severity over the subsequent 24 h. An epidural blood patch was performed at 48 h, and this initially relieved the headache. After discharge from hospital, and 14 days after the dural puncture, the headache recurred, together with expressive dysphasia, poor co-ordination and sensory loss in the right arm. A magnetic resonance imaging scan demonstrated a left sided subdural haematoma, which was drained successfully with complete recovery.

Adult↗
PubMed2001

Adenoviral vector transfection into the pulmonary epithelium after cecal ligation and puncture in rats.

BACKGROUND: Adenoviral-targeted gene delivery to respiratory epithelium can augment production of specific proteins. Therefore, it may be valuable in treating the acute respiratory distress syndrome. The authors tested the hypothesis that adenoviral vector uptake after cecal ligation and double puncture in rats, an animal model of the acute respiratory distress syndrome, is higher than that observed in controls that did not undergo operation ("nonoperated") or those that underwent a sham operation ("sham-operated"). METHODS: Adenoviruses expressing green fluorescent protein or Lac-Z were delivered into the lungs of anesthetized rats via tracheal catheter. Animals were killed 24 or 48 h later. Histopathology and green fluorescent protein expression were examined using light of fluorescence microscopy. Cellular localization of Lac-Z was determined with electron microscopy or semithin sectioning. Viral receptor density and localization were determined using imunoblotting and immunohistochemistry. RESULTS: After cecal ligation and double puncture, rats were hypoxic and tachypneic. Alveoli were segmentally consolidated, contained proteinaceous debris and neutrophils, and had thickened septa. Administration of adenoviruses to rats that were sham-operated or underwent cecal ligation and double puncture resulted in high levels of marker protein expression in cells lining alveoli. Use of 3 x 10(11) plaque-forming units instead of 3 x 10(12) plaque-forming units resulted in similar levels of green fluorescent protein expression with negligible viral-mediated lymphocytic infiltration. Semithin section and electron microscopy revealed expression primarily localized to type II alveolar cells. Abundance of alpha(v)beta3 integrins and human coxsackie-adenovirus receptor (receptors that modulate viral attachment and internalization) was increased after cecal ligation and double puncture, predominantly in type II pneumocytes. CONCLUSIONS: Cecal ligation and double puncture induces histologic and functional changes consistent with the acute respiratory distress syndrome, increases surface expression of viral receptors, and enhances adenoviral-mediated gene transfer.

Adenoviridae↗
PubMed2003

Percutaneous CT-guided puncture and steroid injection for the treatment of lumbar discal cyst: a case report.

STUDY DESIGN: A case report of discal cyst treated by percutaneous CT-guided puncture and steroid injection. OBJECTIVES: To present the efficacy of percutaneous CT-guided puncture and steroid injection for the treatment of this disorder. SUMMARY OF THE BACKGROUND DATA: Surgical removal of the cyst is usually performed for the treatment of this disorder. However, it was recently reported that direct CT-guided puncture and steroid injection was useful for the treatment of intraspinal synovial cyst. METHODS: A 37-year-old man experienced low back pain and right lower extremity pain with sensory abnormality over the right leg and foot. MRI revealed an extradural spherical mass with low signal intensity on T1-weighted imaging and high signal intensity on T2-weighted imaging behind the L5 vertebral body. On discography, contrast medium rapidly flowed into the cyst through a thin channel from the neighboring disc cavity. Based on these findings, a diagnosis of discal cyst was made. Percutaneous CT-guided puncture and steroid injection were performed. RESULTS: Low back pain, right extremity pain, and numbness disappeared immediately after the procedure. On MRI examination, the cyst gradually diminished in size after the procedure. CONCLUSION: CT-guided percutaneous puncture and steroid injection may be a useful procedure for the treatment of discal cyst.

Adult↗
PubMed2006

Osteogenic protein-1 injection into a degenerated disc induces the restoration of disc height and structural changes in the rabbit anular puncture model.

STUDY DESIGN: In vivo study of the effect of injection of osteogenic protein-1 (OP-1) on a rabbit anular needle puncture model of intervertebral disc (IVD) degeneration. OBJECTIVE: To study radiographic, magnetic resonance imaging (MRI), biochemical, and histologic changes in the rabbit IVD after injection of OP-1 into the nucleus pulposus in a needle puncture disc degeneration model. SUMMARY OF THE BACKGROUND DATA: Growth factors, such as OP-1, have the ability to stimulate synthesis of proteoglycans and collagen in vitro. The in vivo injection of OP-1 into the normal rabbit IVD has increased disc height and proteoglycan content in the anulus fibrosus and nucleus pulposus. However, to our knowledge, no attempts have yet been made to determine the effects of these growth factors in an in vivo model of disc degeneration. METHODS: New Zealand adolescent white rabbits (n = 90, 8 for baseline evaluation, 82 at 8 times) received an anular puncture in 2 noncontiguous discs with an 18-gauge needle to induce disc degeneration. Four weeks later, either 5% lactose (10 microL) or OP-1 (100 microg in 10 microL 5% lactose) was injected into the center of the nucleus pulposus. The disc height was followed radiographically for up to 24 weeks after the injections. At the 2, 4, 8, 12, and 24-week times after the injection, rabbits were euthanized, and MRI of the harvested spinal columns was obtained to grade the degeneration. The discs injected with OP-1 or lactose and noninjected discs were subjected to biochemical and histologic analysis. The specimens at the 24-week time were limited to histologic evaluation. RESULTS: The anular puncture with a needle induced a consistent disc narrowing within 4 weeks. The injection of OP-1 induced a restoration of disc height at 6 weeks, which was sustained for the entire experimental period, up to 24 weeks after the injection. The injection of lactose alone did not change the course of disc narrowing over the same time. MRI grading score showed significant differences between the OP-1 and lactose groups at the 8, 12, and 24-week times, suggesting an increase in water content in the nucleus pulposus of the OP-1 group. The proteoglycan content of the nucleus pulposus and anulus fibrosus was significantly higher in the OP-1 group than in the control group. The degeneration grades of the punctured discs in the OP-1 group were significantly lower than those in the lactose group. CONCLUSION: The results of this study show the feasibility of restoring degenerative rabbit discs by a single injection of OP-1 into the nucleus pulposus. Importantly, the effects of the OP-1 injection on disc height were sustained for up to 24 weeks. The metabolic changes in the cells, following a single injection, might be sustained and, thus, induce long-term changes in disc structure. An efficacy study in large animals is required to show further that the intradiscal injection of OP-1, or bone morphogenetic proteins or growth factors with similar properties would be useful for the structural restoration of the IVD in humans.

Animals↗
PubMed1993

Transport of Water and Solutes across Maize Roots Modified by Puncturing the Endodermis (Further Evidence for the Composite Transport Model of the Root).

The effects of puncturing the endodermis of young maize roots (Zea mays L.) on their transport properties were measured using the root pressure probe. Small holes with a diameter of 18 to 60 [mu]m were created 70 to 90 mm from the tips of the roots by pushing fine glass tubes radially into them. Such wounds injured about 10-2 to 10-3% of the total surface area of the endodermis, which, in these hydroponically grown roots, had developed a Casparian band but no suberin lamellae. The small injury to the endodermis caused the original root pressure, which varied from 0.08 to 0.19 MPa, to decrease rapidly (half-time = 10-100 s) and substantially to a new steady-state value between 0.02 and 0.07 MPa. The radial hydraulic conductivity (Lpr) of control (uninjured) roots determined using hydrostatic pressure gradients as driving forces was larger by a factor of 10 than that determined using osmotic gradients (averages: Lpr [hydrostatic] = 2.7 x 10-7 m s-1 MPa-1; Lpr [osmotic] = 2.2 x 10-8 m s-1 MPa-1; osmotic solute: NaCl). Puncturing the endodermis did not result in measurable increases in hydraulic conductivities measured by either method. Thus, the endodermis was not rate-limiting root Lpr: apparently the hydraulic resistance of roots was more evenly distributed over the entire root tissue. However, puncturing the endodermis did substantially change the reflection ([sigma]sr) and permeability (Psr) coefficients of roots for NaCl, indicating that the endodermis represented a considerable barrier to the flow of nutrient ions. Values of [sigma]sr decreased from 0.64 to 0.41 (average) and Psr increased by a factor of 2.6, i.e. from 3.8 x 10-9 to 10.1 x 10.-9 m s-1(average). The roots recovered from puncturing after a time and regained root pressure. Measurable increases in root pressure became apparent as soon as 0.5 to 1 h after puncturing, and original or higher root pressures were attained 1.5 to 20 h after injury. However, after recovery roots often did not maintain a stable root pressure, and no further osmotic experiments could be performed with them. The Casparian band of the endodermis is discontinuous at the root tip, where the endodermis has not yet matured, and at sites of developing lateral roots. Measurements of the cross-sectional area of the apoplasmic bypass at the root tip yielded an area of 0.031% of the total surface area of the endodermis. An additional 0.049% was associated with lateral root primordia. These areas are larger than the artificial bypasses created by wounding in this study and may provide pathways for a "natural bypass flow" of water and solutes across the intact root. If there were such a pathway, either in these areas or across the Casparian band itself, roots would have to be treated as a system composed of two parallel pathways (a cell-to-cell and an apoplasmic path). It is demonstrated that this "composite transport model of the root" allows integration of several transport properties of roots that are otherwise difficult to understand, namely (a) the differences between osmotic and hydrostatic water flow, (b) the dependence of root hydraulic resistance on the driving force or water flow across the root, and (c) low reflection coefficients of roots.

Journal Article↗
PubMed1991

Maintenance of turgor by rapid sealing of puncture wounds in leaf epidermal cells.

When leaf epidermal cells are puncture wounded with a glass microcapillary tip, a small droplet of fluid is discharged and then evaporates, leaving a solid residue on the cell surface. For puncture wounds of about 3.5 micrometers in diameter, this process is complete within 2 to 3 seconds. A second puncture wound also exhibits a similar discharge, indicating the persistence of some turgor pressure within the cell, despite damage to the cell wall. Direct measurement of turgor on the large epidermal cells of Tradescantia virginiana L. demonstrated that turgor was substantially maintained (91-96%) after puncture wounding. Anatomical and histochemical evidence suggests that the damaged portion of the cell wall was sealed with an amorphous plug of material comprised of pectinaceous polysaccharides. Rapid sealing of puncture wounds and the maintenance of turgor in epidermal cells may be an important functional component of plant adaptation to physical damage such as that caused by insect feeding.

Journal Article↗
PubMed1993

Classification and severity of postdural puncture headache. Comparison of 26-gauge and 27-gauge Quincke needle for spinal anaesthesia in day-care surgery in patients under 45 years.

Two hundred and five patients, aged 16-45 years, undergoing day care surgery were given a spinal anaesthetic using either a 26- or a 27-gauge Quincke point spinal needle. The occurrence of headache and accompanying symptoms postoperatively was analysed from 186 returned questionnaires. The incidence of classical postdural puncture headache was 4.5% following the use of a 26-gauge needle and 8% with a 27-gauge needle (p > 0.05). A further group of patients suffering headache after dural puncture was identified, the postdural puncture-related headache. The headache and accompanying symptoms were similar to that seen with a postdural puncture headache except that it was not aggravated by posture. A system of grading the severity of both type of headache is presented and standardised criteria for the classification of postdural puncture headache are proposed.

Adolescent↗
PubMed1996

Dural puncture: the patients' perspective. A patient survey of cases at a DGH maternity unit 1983-1993.

BACKGROUND: This study was designed to investigate the patient experience following accidental dural puncture complicating obstetric epidural analgesia. METHODS: Sixty-three patients who had suffered from accidental dural puncture during obstetric epidural analgesia over a ten-year period were sent a questionnaire enquiring about their experiences. 68% responded. RESULTS: Headache was the most severe symptom, occurring in 86% of this group; it lasted for a median of eight days and recurred after discharge in 47%. Backache occurred in 70% and 58% suffered with backache following discharge. Headache was considered to be the worst aspect by 49% of responders, backache by 19% and bedrest by 33%. Bed rest was frequently voluntary (as opposed to being enforced on medical orders) since many patients only gained relief from their headache when supine. Twenty patients (47%) received a blood patch, which was effective in relieving headache in 14 patients; however, the headache recurred after discharge in 10 of these 14 patients. Only 8 patients (19%) stated that they were aware of the risk of dural puncture prior to their epidural, three of whom were members of paramedical professions. CONCLUSIONS: Headache and backache are both common following dural puncture with a 16 G needle and both frequently recur after discharge from hospital. It was the strongly expressed opinion of this selected group that all mothers should be warned of the risk of dural puncture before undergoing epidural analgesia.

Analgesia, Epidural↗
PubMed1984

Effect of cerebral puncture on brain protein synthesis in adult and young rodents.

In adult mice cerebral puncture results in an inhibition of brain protein synthesis, as suggested previously by Dunn (1975). The inhibition is apparent within a few minutes but subsides by 15 min after puncture. The percent inhibition therefore depends on the length of time between the puncture and the measurement. Mice receiving a puncture were less active than controls, and a decrease in brain temperature was observed in these animals. The decrement is, however, too small to account for the inhibition of synthesis. Diphenylhydantoin had no effect on the inhibition. Cerebral puncture of young mouse (7-day-old) or rat (8-day-old) brain induced no inhibition of brain protein synthesis.

Aging↗
PubMed1993

Accidental dural puncture in obstetric patients and long term symptoms.

OBJECTIVE: To examine the association between accidental dural puncture and long term headache and related symptoms. DESIGN: Postal questionnaire survey to elucidate new symptoms occurring after childbirth, and linking of these to data in obstetric and anaesthetic case notes. Women were surveyed between 13 months and nine years after delivery. SETTING: Birmingham Maternity Hospital. SUBJECTS: 4700 women who had delivered their most recent baby under epidural anaesthesia, 74 of whom had suffered an accidental dural puncture. MAIN OUTCOME MEASURES: Frequencies of new headache or migraine or neck ache starting within three months after childbirth and lasting over six weeks. RESULTS: Among the 74 women who had had an accidental dural puncture there were 17 (23%) who reported one or more of the above symptoms. By comparison, among those who had had an epidural anaesthetic but no recorded puncture, only 329 (7.1%) reported these symptoms. The duration of the headache or migraine or neck ache in the dural tap group ranged from nine weeks to over eight years. Ten of these women reported still unresolved symptoms. CONCLUSIONS: Conclusions on causality were tentative. Most women would remember a dural tap, and this might influence their reporting of subsequent symptoms attributable to the event. In addition, detailed characterisation of the symptoms was not available. Nevertheless, the findings provide a clear indication of the need for further study of the possible long term sequelae of accidental dural puncture.

Accidents↗
PubMed1996

Plantar puncture wounds: a survey to determine the incidence of infection.

OBJECTIVE: To determine the incidence of plantar puncture wound infections. METHODS: Ambulatory emergency patients were surveyed with regard to a previous history of plantar puncture wounds and any subsequent infections. RESULTS: 200 questionnaires were analysed. Forty four percent of respondents had previously sustained at least one plantar puncture wound. Of 156 wounds, 79 (50%) came to the attention of a physician. There were 10 infections, nine of which were seen by a physician. Counting only those wounds seen by a physician, the apparent infection rate in the study population is 11.4%. When all wounds are included, the infection rate is 6.4%. CONCLUSIONS: The infection rate of plantar puncture wounds is lower than most studies report because many wounds with a benign outcome never come to medical attention. Recommendations for treatment of fresh puncture wounds in the emergency department should be evaluated in light of this infection rate.

Adolescent↗
PubMed1982

Puncture of thoracic lesions under sonographic guidance.

Thirty-six punctures of thoracic lesions have been performed with a compound B-scanner or a real-time linear-array scanner for guidance. Twenty-three fluid collections were punctured and aspiration biopsies were performed on 13 echogenic lesions. All the punctures were successful at the first attempt. No complications occurred. The results confirm the usefulness of sonography for guiding punctures of thoracic fluid effusions and solid masses. Usually a static B-scanner is sufficient, but when masses are small or surrounded by vital structures puncture may be controlled by a real-time scanner.

Adult↗
PubMed1978

Percutaneous punctures: a new radiological skill.

Percutaneous aspiration or biopsy of abdominal masses is being performed with increasing frequency. Percutaneous puncture under fluoroscopic control is the simplest technique; it has the advantage that contrast media can be inserted into a cyst to outline its walls. Ultrasound can play an important role in guiding punctures if the mass or organ to be punctured cannot be seen on a radiograph or will be approached from an unusual angle. CT scanning is the preferred procedure for guiding the puncture of bone lesions and some small structures. The author concludes there may soon be a need for abdominal-puncture experts.

Biopsy, Needle↗
PubMedDate not supplied

Simulated digestion status of intact and exoskeletally-punctured insects and insect larvae: a spectroscopic investigation.

In this study, we tested the hypothesis that puncturing the chitin exoskeleton of insect and insect larvae food sources aids the ingress of digestive fluids and increases the rate of digestion and energy uptake in insectivorous mammals. For this purpose 10 crickets (Acheta domesticus) and 10 mealworms (Tenebrio molitor larvae) were divided into two groups of 5; one group was punctured using a small blade to mimic the effect of a single bite, the remainder serving as controls. The insects were then individually immersed in 5 ml of a 1 x 10(-2) mol.dm(-3) solution of hydrochloric acid (pH 2.0) for a period of 2 h in order to mimic digestion in the stomach. The matrix was then centrifuged and the supernatant fluid subjected to spectrophotometric and high-resolution proton (1H) NMR analysis. Electronic absorption spectra of these supernatants revealed that puncturing the exoskeleton of mealworms and crickets gave rise to substantial elevations (up to 14-fold) in the concentrations of UV-absorbing biomolecules (p < 0.025 for both species). The 400-MHz 1H NMR profiles of supernatants derived from mealworm and cricket specimens with punctured exoskeletons contained a wide variety of prominent biomolecule resonances, whereas those from unpunctured (control) insects contained signals of a much lower intensity, ascribable only to selected biomolecules. We conclude that puncturing the cuticle of insects and insect larvae prior to swallowing confers significant nutritional advantages over swallowing prey whole.

Animal Nutritional Physiological Phenomena↗
PubMed1997

Calcaneal osteomyelitis caused by nail puncture wounds.

Plantar puncture wounds to the foot are a common injury. A small number (1.8%) of these puncture wounds become infected and progress to osteomyelitis. The purpose of this article is to report the cases of six patients who developed osteomyelitis of the calcaneus after a puncture wound to the heel caused by a nail. The characteristics of the patients, the pathogenic organism, and the outcome were studied. Patients who were healthy and had no systemic illness (N = 4) had only one pathogenic organism cultured, whereas patients who had systemic illness (diabetes mellitus, N = 2) had more than one pathogenic organism cultured. The only amputation in this group occurred in a patient with diabetes mellitus. It was concluded that diabetic patients who develop calcaneal osteomyelitis from a nail puncture wound are more likely to have multiple pathogens cultured. Furthermore, if a diabetic neuropathy is also present, the nail puncture wound may be the initial injury leading to a chronic ulceration, increasing the risk of amputation.

Calcaneus↗