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PubMed1978

[Puncture of a bronchial tumor in the bronchoscopic diagnosis of lung cancer].

An analysis of the results of bronchial tumor biopsy performed in 200 lung cancer patients is reported. Morphological verification proved feasible in 193 of 200 patients. Biopsy and puncturing of the tumor are found to be most advantageous technics for the material take during bronchoscopy. Contrary to biopsy, an efficiency of transbronchial puncturing is not affected by the character of tumor growth and its morphological structure. A combined use of biopsy and puncture makes it possible to increase the percentage of morphologically supported diagnosis of pulmonary cancer. Transbronchial puncturing is also an efficient maneuver for detection of cancer recurrence in the bronchial stump and a residual tumor after conservative therapy. Endoscopic signs of the peribronchial pattern of tumor growth are absolute indications to its puncture.

Adenocarcinoma↗
PubMed1980

[Hemobilia after Menghini puncture].

In 100 patients before and after a percutaneous blind puncture of the liver after Menghini biliary juice was received with the help of a duodenal sound and this was investigated for blood admixtures microscopically and chemically. In 21 out of 100 punctures patients blood was proved in the duodenal juice: In 11 cases the proof of blood was positive before and after the puncture and in 10 patients only after the puncture blood was found in the duodenal juice. A macrohaemobilia was never observed. The influence of thromboplastin time, number of thrombocytes, time of haemorrhage, age and basic disease on the development and support of microhaemobilia was examined. In about 10% of the patients is to be reckoned with a microhaemobilia taking into consideration the indication and contraindication, also in exact performance of the blind puncture of the liver. However, the clinical importance is little in general.

Adult↗
PubMed1980

[Transthoracic puncture biopsy (author's transl)].

917 patients with intrapulmonary lesions were studied by transthoracic needle biopsy. 460 cases in which both the puncture technique (general anaesthesia with artificial ventilation using a CARLENS' doublelumen catheter, puncture under X-ray amplifier-TV-guidance) and the control measures (fluoroscopy immediately performed after the puncture biopsy X-ray film 24 hours later) in accordance were analysed. The diagnostic yield was 72.5% in disseminated lung lesions using HAUSSER'S split needle. In localized coinlike lesions there was a positive diagnostic rate of 72.6%. The complication rate in these two groups was 63% and 54.8% respectively (p > 0.05). The authors use the transthoracic puncture biopsy in relation to the roentgenologic appearance and to the localization of the pathologic structures. They decline to perform the transthoracic puncture biopsy as a bed side method.

Anesthesia, General↗
PubMed1993

[Optimization of the image intensifier-assisted technique of lumbar sympathetic block. Computed tomographic simulation of a paravertebral puncture access].

The paravertebral approach is the most common technique for local anaesthetic and neurolytic lumbar sympathetic blocks. However, guidelines on the site of needle insertion differ. As there have been several case reports on accidental trauma to the ureter and the kidney, this study was undertaken to evaluate the site of paravertebral needle insertion and the fluoroscopic landmarks for lumbar sympathetic blocks by computed tomographic puncture simulation. METHODS. CT scans of 73 patients at the level of L2-4 were analysed with respect to the location of kidneys, the vertebral insertion of the diaphragm, the distance of the sympathetic trunk from the ventral and lateral border of the lumbar vertebrae, the paravertebral distance of a tangent from the sympathetic trunk through the kidney surface and the frequency of inadvertent puncture of major organs by different paravertebral approaches. For needle insertion distances of 6, 8, 10 and (at the level of L4) 12 cm lateral to the midline were simulated. RESULTS. Simulating a paravertebral approach of 6 cm resulted in perforation of the right (or left) kidney only at the level of L2 in 1.4% (2.8%) of cases. The incidence of accidental renal puncture due to a paravertebral approach of 8 cm was 26.0%, 4.1% and 0 (26.0%, 2.7% and 0) at the levels L2, L3 and L4, respectively. A more lateral insertion of needles 10 cm from the spinous process increased the frequency of anticipated renal puncture to 57.5%, 19.2% and 1.4% (65.8%, 26.0% and 1.4%); in addition, perforation of liver parenchyma was detected in two cases. Although the lower pole of the kidney reached the mid-vertebral level of L4 in only 23.3 (15.1)% of cases, a lateral approach 12 cm from the midline still showed a 8.2 (4.1)% incidence of kidney perforation and inadvertent trauma to the intestine in two cases. The mean distance from the sympathetic trunk to the ventral border of the lumbar vertebra (in simulation of a lateral fluoroscopic view) was 0.80, 0.66 and 0.59 cm, analogous measurements to the lateral border averaged 0.37, 0.43 and 0.50 cm at L2, L3 and L4, respectively. At the level of L2 the medial insertion of the diaphragm was identified in 45% of patients in close anatomical relationship to the psoas fascia. CONCLUSION. In order to reduce the risk of accidental trauma to major organs the paravertebral distance of insertion of the needles from the midline should not exceed 6, 7 and 10 cm for lumbar sympathetic blocks at the levels of L2, L3 and L4, respectively. However, a paravertebral approach of less than 6 cm may cause a lateral and ventral deviation of the needle from the sympathetic chain. Under fluoroscopy a correct needle position is obtained at an average distance of 0.5-0.8 cm dorsal to the anterior vertebral border, advancing the needle to the ventral border may cause an accidental puncture of the vena cava in more than 20% of patients undergoing nerve block of the right sympathetic chain. Furthermore, at the level of L2 inadvertent placement of the needle tip within the vertebral insertion of the diaphragm must be considered as a reason for atypical spread of contrast medium.

Anesthesia, Spinal↗
PubMed1995

Malignant cells revealed in fine needle punctures of lymph nodes and tumours by electronmicroscopical methods.

Cytological, immunohistological and electron microscopical observation of 21 percutaneous fine needle punctures of retroperitoneal, pelvic and abdominal lymph nodes after borderline lymphography and computer tomography and 6 punctures of tumours after tomography allowed classification of primary metastases from the small pelvis in 14 patients and characterized tumours in 4 patients, which could not be demarcated by sonography. We distinguished yolk sarcoma metastasis, prostate gland cancer metastasis, three cases of nodular metastases of seminoma cells, and two metastases of melanoma. Malignant cells of Hodgkin's lymphogranuloma and non-Hodgkin's lymphoma were distinguished in seven samples of fine needle puncture. We found malignant cells of adenocarcinoma, T-immunoblastoma, pancreas carcinoma and histiocytosis X in four punctures of tumours. Fine needle puncture processed for electron microscopy with buffered fixation and harvested into Lowicryl K4M resin through centrifugation makes it possible to detect even the minimum of cells present, preserves the structure of cells and enables to correlate cytological findings in semithick sections with correspond ultrastructure in followed series of semithin sections.

Abdominal Neoplasms↗
PubMed1996

[Pyogenic osteomyelitis after a plantar puncture wound: analysis of a series of 8 cases].

BACKGROUND: The aim of this study was to know the incidence of osteoarticular infection secondary to plantar puncture, in the authors' center, and review the clinical characteristics, diagnosis and treatment. PATIENTS AND METHODS: A retrospective analysis of the cases of osteomyelitis and/or pyogenic arthritis secondary to plantar puncture admitted from 1986 to 1994 in the authors' hospital. RESULTS: Eight cases of osteoarticular infection secondary to plantar puncture (all males with a mean age of 37.2 years) were analyzed with a prevalence of 1.65% out of the total number of plantar punctures attended in the emergency department. The mechanism of the wound was, in all the cases, that of stepping on a nail. The most frequent clinical manifestations were pain and signs of local inflammation. Systemic repercussion was not observed in any case. A monomicrobial culture was obtained in 6 cases (in five P. aeruginosa was isolated). Combined surgical and antibiotic treatment was performed in 7 patients. A foreign body was found in only one case. The mean length of antibiotic treatment was five weeks. CONCLUSIONS: Initial surgical treatment of plantar punctures is fundamental, in addition to home instructions and follow up to avoid late severe infectious complications. The role of radiology and other diagnostic imaging techniques should be considered to detect foreign bodies. The role of prophylatic antibiotics is controversial but may be indicated in certain cases.

Adult↗
PubMed2006

Bevel direction and postdural puncture headache: a meta-analysis.

BACKGROUND: The effect of lumbar puncture needle bevel direction on the incidence of postdural puncture headache (PDPH) is somewhat controversial. We performed a meta-analysis of available trials to determine if bevel direction during lumbar puncture would influence the incidence of PDPH. REVIEW SUMMARY: Studies were identified primarily by searching the National Library of Medicine's PubMed database (1966 to November 29, 2004) and abstracts from several national meetings (American Society of Anesthesiology, International Anesthesia Research Society, American Society of Regional Anesthesia, Society of Obstetric Anesthesia and Perinatology) for terms related to needle and bevel direction. Inclusion criteria were assessment of the incidence of PDPH after lumbar puncture with a cutting needle (eg, Quincke, Tuohy), comparison of a "parallel" (bevel oriented in a longitudinal or cephalad to caudad direction) to "perpendicular" (bevel oriented in a transverse direction) orientation during needle insertion, randomized trials, and trials primarily in adult populations. Data on study characteristics and incidence of PDPH were abstracted from qualified studies and subsequently analyzed. The search resulted in 52 abstracts from which the original articles were obtained and data abstracted, with ultimately a total of 5 articles meeting all inclusion criteria. Insertion of a non-pencil-point/cutting needle with the bevel oriented in a parallel/longitudinal fashion resulted in a significantly lower incidence of PDPH compared with that oriented in a perpendicular/transverse fashion (unadjusted rates of 10.9% versus 25.8%; odds ratio = 0.29 [95% CI = 0.17-0.50]). CONCLUSIONS: Our meta-analysis indicates that with use of a cutting needle, insertion in a parallel/longitudinal fashion may significantly reduce the incidence of PDPH, although the reasons for this decrease are unclear.

Arachnoid↗
PubMed2026

Comparative Evaluation of Virtual Reality versus Standard Nursing Care in Managing Pain and Fear during Lumbar Puncture Procedures: A Randomised Controlled Trial.

BACKGROUND: Meningitis is a serious infectious disease that can cause significant morbidity and long-term neurological problems. Although a lumbar puncture is a necessary diagnostic procedure, it is often accompanied by discomfort, anxiety, and fear, which can severely impact the patient's experience. Although there is few data on its application prior to lumbar puncture in adult patients with meningitis, immersive virtual reality (VR) has become a promising non-pharmacological technique for lowering procedural distress. Thus, among individuals undergoing lumbar punctures, this randomized controlled research assessed how well pre-procedural VR reduced pain, anxiety, and fear while enhancing patient satisfaction. OBJECTIVE: This study aims to evaluate the effectiveness of virtual reality (VR) in reducing pain and fear among adults undergoing lumbar puncture (LP) compared with standard care protocol. METHODS: A randomised clinical trial was conducted from May to October 2025, using a single-blind, true experimental design. A total of 85 patients were randomly assigned to either the VR intervention group ( n = 41) or the control group receiving standard care ( n = 44). Pain levels were assessed using a visual analogue scale. Fear was assessed using the Multidimensional Fear-of-Injection Scale. Data were analysed using SPSS version 26. RESULTS: According to the study, the findings revealed a significant reduction in pain levels among the study group following the VR intervention, with mean pain scores dropping from 7.54 ± 1.925 to 2.49 ± 0.675. In contrast, the control group showed increased pain intensity, with mean scores rising from 6.84 ± 1.842 to 8.36 ± 1.348. The VR group showed a significant reduction in fear scores across all domains, whereas no significant changes were observed in the control group. Direct fear decreased from 20.12 ± 1.71 to 9.44 ± 2.00, indirect fear from 17.24 ± 1.46 to 8.66 ± 2.24, physiological response improved from 0.34 ± 0.66 to 3.00 ± 1.00 and avoidance behaviour decreased from 16.71 ± 1.49 to 7.80 ± 1.85. CONCLUSIONS: The research shows that the use of VR prior to LP significantly reduces level of pain and fear compared to standard care. These results support VR as a non-pharmacological intervention for fear and pain to improve patient experience during invasive procedures. In contrast, the control group experienced no improvement.Trial Registration: The IRCT code for the trial was IRCT ID 20250803066743N1.

Humans↗
PubMed1965

A NEW APPROACH IN DISPENSING TUBERCULIN PPD AND IN PERFORMING A MULTI-PUNCTURE TUBERCULIN TEST.

A simple and low-cost kit for single-dose tuberculin testing is described. For those who perform occasional tuberculin tests only, this kit is proposed as a substitute for the Heaf apparatus used in carrying out a multi-puncture test. No difference in the tuberculin skin reactions could be observed when the needle multi-puncture test was compared with the Heaf test in BCG-sensitized guinea pigs and in 12 volunteers. A comparative study on 37 student nurses, using the needle multi-puncture method and the intracutaneous method (Mantoux test), showed that with the needle multi-puncture method more positive reactors were detected than with the Mantoux test using 1:2000 dilution of OT. However, more positive reactors were obtained with the Mantoux test using 1:100 dilution of OT. It is felt that the singledose kit can be a valuable asset when only few skin tests are performed.

Animals↗
PubMed1991

Tracheostomal stenosis after immediate tracheoesophageal puncture.

The incidence of tracheostomal stenosis in a group of patients after total laryngectomy with or without pharyngectomy plus immediate tracheoesophageal or tracheogastric puncture was compared with that of a control group without puncture. The stenosis rate of the puncture group was significantly higher than that of the control group (19% vs 6%). The other probable etiologic factors for stomal stricture were similar in both groups. Analysis of the risk factors in the puncture group suggested a higher tendency of stenosis in females (43% vs 16%) and in patients receiving postoperative radiotherapy (29% vs 14%), although the difference failed to reach statistical significance.

Adult↗
PubMed1983

The effect of lumbar puncture position in sick neonates.

Clinical deterioration has been observed in sick neonates during lumbar puncture. This study was done to determine if hypoxemia occurred during lumbar puncture, if hypoxemia was position dependent, if transcutaneous PO2 (TcPO2) monitoring effected hypoxemia, and what possible mechanisms were involved. Twenty-six neonates received lumbar punctures in either a standard lateral knee-chest position, sitting position, or modified lateral without knee-chest position. Care was taken not to extend or flex the neck. Mean TcPO2 was lower for standard lateral than sitting or modified lateral positions. The time TcPO2 was under 50 mm Hg was greater for standard lateral positions than sitting or modified lateral positions. Increased intraesophageal pressure, in the standard lateral position, suggests extrathoracic compression of the chest by the abdominal contents. We recommend lumbar punctures be done in the sitting or modified lateral position.

Birth Weight↗
PubMed1981

Lumbar puncture-induced meningitis.

A retrospective study was done to evaluate the risk of lumbar puncture-induced meningitis. Fourteen percent (23/165) of patients with bacteremia caused by Streptococcus pneumoniae, Haemophilus influenzae, Neisseria meningitis, and groups A and B streptococci had spontaneous meningitis (without a preceding lumbar puncture). In contrast, only 0.8% (7/924) of patients with blood culture containing other organisms had spontaneous meningitis and 2.1% (3/140) of these patients had clinical courses consistent with lumbar puncture-induced meningitis. However, the 2.1% incidence in the latter group is not significantly different from 0.8%, the expected incidence of spontaneous meningitis. It is suggested that if lumbar puncture-induced meningitis does occur, it is rare enough to be clinically insignificant.

Adult↗
PubMed2004

Arterial puncture closing devices compared with standard manual compression after cardiac catheterization: systematic review and meta-analysis.

CONTEXT: Arterial puncture closing devices (APCDs) were developed to replace standard compression at the puncture site and to shorten bed rest following percutaneous coronary intervention. OBJECTIVE: To assess the safety and efficacy of APCDs (Angioseal, Vasoseal, Duett, Perclose, Techstar, Prostar) compared with standard manual compression in patients undergoing coronary angiography or percutaneous vascular interventions. DATA SOURCES: A systematic literature search of MEDLINE (1966-January 2003), EMBASE (1989-January 2003), PASCAL (1996-January 2003), BIOSIS (1990-January 2003), and CINHAL (1982-January 2003) databases and the Cochrane Central Register of Controlled Trials for relevant articles in any language. STUDY SELECTION: Included randomized controlled trials reporting vascular complications at the puncture site (hematoma, bleeding, arteriovenous fistula, pseudoaneurysm) and efficacy (time to hemostasis, time to ambulation, time to discharge from hospital). DATA EXTRACTION: Two reviewers abstracted the data independently and in duplicate. Disagreements were resolved by discussion among at least 3 reviewers. The most important criteria were adequacy of allocation concealment, whether the analysis was according to the intention-to-treat principle, and if person assessing the outcome was blinded to intervention group. Random-effects models were used to pool the data. DATA SYNTHESIS: Thirty trials met the selection criteria and included up to 4000 patients. When comparing any APCD with standard compression, the relative risk (RR) of groin hematoma was 1.14 (95% confidence interval [CI], 0.86-1.51; P =.35); bleeding, 1.48 (95% CI, 0.88-2.48; P =.14); developing an arteriovenous fistula, 0.83 (95% CI, 0.23-2.94; P =.77); and developing a pseudoaneurysm at the puncture site, 1.19 (95% CI, 0.75-1.88; P =.46). Time to hemostasis was shorter in the group with APCD compared with standard compression (mean difference, 17 minutes; range, 14-19 minutes), but there was a high degree of heterogeneity among studies. Only 2 studies explicitly reported allocation concealment, blinded outcome assessment, and intention-to-treat analysis. When limiting analyses to only trials that used explicit intention-to-treat approaches, APCDs were associated with a higher risk of hematoma (RR, 1.89; 95% CI, 1.13-3.15) and a higher risk of pseudoaneurysm (RR, 5.40; 95% CI, 1.21-24.5). CONCLUSIONS: Based on this meta-analysis of 30 randomized trials, many of poor methodological quality, there is only marginal evidence that APCDs are effective and there is reason for concern that these devices may increase the risk of hematoma and pseudoaneurysm.

Aneurysm, False↗
PubMed2003

Transthoracic left ventricular puncture for the assessment of patients with aortic and mitral valve prostheses: the Massachusetts General Hospital experience, 1989-2000.

Accurate assessment of suspected prosthetic valve dysfunction is critically important as reoperation carries high risk. Noninvasive methods of hemodynamic assessment of patients with both aortic and mitral mechanical valves continue to be frustrated by the interference created by prosthetic material and direct left ventricular puncture may be required for definitive hemodynamic assessment. We report the hemodynamic and angiographic results and outcomes of 38 consecutive patients with double valve replacement who underwent left ventricular puncture as part of evaluation of possible prosthetic dysfunction. These results were compared with those obtained by noninvasive testing. We found noninvasive assessment alone to be unsatisfactory as measurements of regurgitation and stenosis correlated poorly with those obtained by direct left ventricular puncture. Important information that altered patient management was obtained from invasive assessment in 68% of cases with an acceptable rate of complications. Therefore, hemodynamic and angiographic assessment using transthoracic left ventricular puncture should be entertained in patients with mitral and aortic valve replacement presenting with congestive heart failure and suspected prosthesis dysfunction.

Aortic Valve↗
PubMed1977

Usefulness of transtracheal puncture and aspiration in the bacteriological diagnosis of pulmonary tuberculosis.

Transtracheal puncture enables two samples of bronchial secretions to be taken-the product of transtracheal aspiration and simultaneously expectorated sputum (obtained in 71% of the cases)-for the purpose of testing for Mycobacterium tuberculosis in cases of suspected pulmonary tuberculosis. Two groups of patients were studied: Group I: 100 patients who were poor expectorators and who all underwent transtracheal puncture; Group II (Control): 100 patients who expectorated well or who had been given gastric lavages immediately on admission. Laboratroy analyses revealed M. tuberculosis in at least one of the samples obtained from each of the 200 patients. The authors compare the efficiency of the methods used within each group and between the two groups. Samples obtained by transtracheal aspiration and simultaneous expectoration (75% of positive results) more often contained M. tuberculosis than the other Group I samples (64% of total positive results; 64% of positive results for spontaneous sputa, 65% for gastric fluids), and as often as the Group II samples (76% of total positive results), particularly the expectoration samples (78% of positive results). Simultaneously expectorated sputum more frequently contained M. tuberculosis (82% of positive results) than transtracheal aspiration (69% of positive results). Transtracheal puncture and/or simultaneous expectoration were the only examinations revealing M. tuberculosis in 34 patients in Group I. Non-specific bacteriological findings are not relevant. However, the authors point out that this technique is not always innocuous (although no serious complications were observed in this series), and that transtracheal puncture must always be carried out by physicians trained in the technique.

Adult↗
PubMed1985

Anatomical basis of intervertebral disc puncture with chemonucleolysis.

Transparietal puncture of the lumbar intervertebral discs is done to achieve enzymatic nucleolysis. This technique requires firm understanding of the morphology and topography of the anatomical structures traversed by the needle as well as those to be avoided. Vertebral disc puncture with chemonucleolysis has been done by the author for four years. The aim of this study was to identify the parameters allowing facilitation of this procedure, thereby leading to a decreased X-ray exposure. To achieve this goal an analytical study of the target structure and its neurovascular, osseous and visceral relations was carried out. The results of this study led to practical conclusions regarding especially the parameters of disc puncture, their preoperative identification and the risks encountered in case of erroneous puncture.

Chymopapain↗
PubMed1985

A new set of instruments for sonographically controlled follicular puncture.

A new device for sonographically controlled follicular puncture was introduced which improves both safety and comfort during egg retrieval. A steering attachment developed especially for the transducer of the DIASONICS DS 1 sector scanner increased the precision of transabdominal-transvesical follicular puncture. The "two-instrument method" (aspiration needle gliding smoothly within a trocar) ensured highly reliable, continuous sonographic imaging of the aspiration needle as well as precise puncture without the procedure being hindered by tissue resistance. Sonographically controlled follicular puncture under epidural anesthesia reduces procedure-related risk and patient stress.

Anesthesia, Epidural↗
PubMed1990

[Knee puncture via a closed system].

Punctures of the joints, particularly the knee joint are performed quite often in every day practice. There are relatively simple procedures and carry a very low rate of infection. Infections of the joint space secondary to joint punctures are rare but catastrophic when they do occur. This new method of joint puncture operates in a closed system and provides the possibility of intraarticular administration of drugs, an act which will help to reduce the chances of infection after joint punctures or operations.

Drainage↗