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PubMed1998

Postdural puncture headache and transient neurologic symptoms in children after spinal anaesthesia using cutting and pencil point paediatric spinal needles.

BACKGROUND: In the last decade the use of spinal anaesthesia (SA) in paediatric anaesthesia has increased. In adults, pencil point spinal needles are supposed to be less traumatic and hence to be superior compared with cutting point needles in respect of postpuncture complaints. In children, the use of spinal needles with a special tip design have not been compared. The aim of this study was to study the clinical utility and postpuncture characteristics of four newly designed spinal needles in paediatric surgery. METHODS: In this open-randomised, parallel groups, prospective study we compared the puncture quality, success rate and postpuncture characteristics in 200 children aged 2 to 128 months. Two cutting point needles; a 50-mm-long 25G Quincke and a 25-mm-long 26G Atraucan were compared with two pencil point needles; a 37-mm-long 27G Whitacre and a 35-mm-long 24G Sprotte. The children were premedicated with oral diazepam and those anxious or uncomfortable after premedication were sedated with i.v. thiopentone or propofol. Bupivacaine 5 mg ml-1 0.3-0.5 mg kg-1 was used for the SA. RESULTS: The spinal puncture was successful with one or two skin punctures in 96% of children. The cutting point needles were easier to insert through the skin and ligaments (P = 0.001) but the pencil point needles gave a better (P = 0.001) indication of the dural passage. The success rate of the SA was 91% without differences between the needles. Five patients were given general anaesthesia and 13 children a single dose of i.v. fentanyl/sedative. The spinal block was completed in less than 3 min in 96% of the cases without differences between the needles. Seventeen children developed a headache, 10 of which were classified as a postdural puncture headache (PDPH), 3 with the Sprotte, 3 with the Quincke and 4 with the Atraucan needles. The youngest child developing PDPH was a 12-month-old boy. Eight of the PDPH were mild and 2 moderate. Ten children developed a low back pain, 2-3 in each study group. Three children in the pencil point groups developed signs of transient radicular irritation. CONCLUSION: SA using bupivacaine and the study needles produced smooth and safe anaesthesia for paediatric surgery with a high success rate. PDPH after SA is as common in children (5%) as in adults although most often mild and short lasting. SA using bupivacaine can cause transient radicular irritation.

Anesthesia, Spinal↗
PubMed2005

Laparoscopic ovarian drilling in the treatment of polycystic ovary syndrome: how many punctures per ovary are needed to improve the reproductive outcome?

AIM: To evaluate the biochemical, clinical and reproductive results after laparoscopic ovarian drilling that carried out a different number of punctures in the ovaries. METHODS: Sixty-three clomiphene-citrate-resistant women with polycystic ovary syndrome (PCOS) underwent laparoscopic ovarian drilling using insulated needle cautery. Patients were allocated to two groups: group I (n = 26) had five punctures per ovary, and group II (n = 37) had 10 punctures per ovary. Biochemical and clinical data, before and after the procedure along with the reproductive outcome, were compared between the two groups. RESULTS: There were no significant differences in terms of body mass index, and insulin and glucose levels before and after the procedure between the two groups. Androgen levels and luteinizing hormone concentrations showed a statistically significant decrease after the treatment. The clinical and reproductive outcome, including menses cyclicity, ovulation, and pregnancy rates were similar in both groups. CONCLUSION: Laparoscopic ovarian drilling is an effective treatment in clomiphene-citrate-resistant women with PCOS. Five, instead of > or = 10, punctures per ovary are sufficient to ameliorate the hyperandrogenic status in these women, improving their clinical and reproductive outcome.

Adult↗
PubMed1990

Foley catheter balloon puncture and the risk of free fragment formation.

The incidence of free fragment formation following balloon puncture or spontaneous bursting was examined in 294 Foley catheters immersed for 48 h in urine. The catheters were divided into 3 groups: 100 were inflated to the manufacturer's recommended volume, 100 to twice the volume and 94 to 3 times the recommended volume. The catheter balloons were punctured by pricking with a hypodermic needle. The overall incidence of free fragment formation was 27.3%. For both types of catheter examined, increasing balloon volume was not associated with an increased risk of free fragment formation following puncture. However, increasing volume was associated with increased free fragment formation when the balloon burst spontaneously. In view of the high risk of free fragment formation, cystoscopy should be performed in all cases of spontaneous catheter balloon rupture or after percutaneous balloon puncture.

Catheters, Indwelling↗
PubMed1998

Significant reduction in post-lumbar puncture headache using an atraumatic needle. A double-blind, controlled clinical trial.

A characteristic headache occurs in about 36-55% of patients after lumbar puncture, and many of these patients need bed rest for one or more days to get relief. In a double-blind randomized trial we compared a new 22-gauge atraumatic puncture needle with the most widely used 20-gauge "conventional" needle. In 49 patients randomized to the atraumatic needle, post-lumbar puncture headache occurred in 6%, whereas in the 50 patients randomized to the conventional needle this occurred in 32% (p = 0.001). On the basis of these results we recommend use of the atraumatic needle in order to diminish the frequency of post-lumbar puncture headache.

Adult↗
PubMed1979

Incidence and effect of traumatic lumbar puncture in the neonate.

The incidence of non-traumatic, traumatic and unsuccessful lumbar punctures in 181 neonates was similar whether a needle with a stylet, a butterfly needle without stylet, or a standard venipuncture needle without stylet was used. Comparison of 20 lumbar puncture pairs in 17 patients showed that traumatic lumbar puncture does not result in a cerebrospinal fluid pleocytosis between two and 13 days after initial traumatic lumbar puncture.

Erythrocyte Count↗
PubMedDate not supplied

Percutaneous puncture of zygapophysial joint synovial cyst with fluoroscopic guidance.

OBJECTIVE: To introduce a minimally invasive, percutaneous fluoroscopic technique for treating symptomatic zygapophysial joint (z-joint) synovial cysts. METHODS: Chart review to describe the clinical presentation, representative imaging, technical procedural details, and follow-up of a 72-year-old female with a symptomatic lumbar z-joint synovial cyst. RESULTS: Before the cyst puncture, the patient failed conservative care including transforaminal epidural and intra-articular z-joint injections. Immediately after the puncture, and at 4-month follow-up, the patient was free of left lower extremity radicular pain. Computed tomography at 4 months post puncture showed resolution of the cyst. There was no recurrence of left leg pain at 30-month follow-up. CONCLUSION: This technical case report illustrates that puncture of an intraspinal z-joint synovial cyst using an interlaminar approach with fluoroscopic guidance may be safely performed with effective relief of radicular symptoms.

Aged↗
PubMed2005

Prospective study of axillary vein puncture with or without contrast venography for pacemaker and defibrillator lead implantation.

Axillary vein puncture may be used to implant pacemaker (PM) or cardioverter defibrillator leads, though usually requires venography. We prospectively compared punctures guided by venography versus a new radiological landmark. In 232 patients, the puncture was guided by injecting diluted contrast material via an ipsilateral peripheral vein (group A, n = 142), or without venography using the intersection of the lateral borders of the second and third rib as a radiological landmark, followed by contrast injection in case of failure (group B, n = 90). We implantated 1-3 leads per patient. In group A, implantation was successful in 135 patients (95%) and in group B in 55 patients (61%, P < 0.001 vs group A). Subsequent contrast injection allowed successful implantations in 34 of 35 patients, with an success rate of 97% for the overall study population of 224 patients. Venous access was achieved after a mean of 10.4 +/- 3.2 minutes of skin incision in group A versus 9.4 +/- 3.0 minutes in group B (ns). Pneumothorax occurred in two patients (1% overall). Thus non-contrast guided puncture using a new radiological landmark was successful in a majority of patients. This technique may be useful in absence of ipsilateral peripheral vein access, or presence of contrast allergy.

Aged↗
PubMedDate not supplied

Ultrasound-guided atlanto-occipital puncture for myelography in the horse.

Complications of cervical myelography arising from the puncture of the subarachnoid space to collect the cerebrospinal fluid and to inject the contrast medium have been described in humans and animals. In this study, 2 ultrasound-guided procedures were developed for puncture of the atlanto-occipital subarachnoid space, collection of cerebrospinal fluid, and injection of contrast medium. Myelography was performed on 6 ataxic horses using these procedures. The first attempt to puncture the subarachnoid space was successful in 5 horses and in one horse, a second attempt was necessary. Collection of cerebrospinal fluid and injection of contrast medium were achieved without difficulty. Ultrasound-guided myelography allowed reduction of potential complications associated with blind percutaneous puncture of the subarachnoid space. Methods described in this study should be tried-at least initially in an experimental setting--to collect cerebrospinal fluid from the atlanto-occipital site in standing horses where it may represent an alternative method when lumbosacral cerebrospinal fluid collection has been unsuccessful or contaminated with blood.

Animals↗
PubMed1982

Lumbar puncture in spontaneous subarachnoid haemorrhage.

Seventy-four patients with proved spontaneous subarachnoid haemorrhage were studied. Sixty-four underwent computed tomography and 55 underwent lumbar puncture. Seven cases deteriorated dramatically after lumbar puncture, six of these showing evidence of cerebral dislocation on further investigation. Four of the seven had not undergone computed tomography and three underwent computed tomography after lumbar puncture. Computed tomography of the brain could determine patients at risk of coning. It is suggested that computed tomography is the investigation of choice after spontaneous subarachnoid haemorrhage and that lumbar puncture, if still then necessary, should be avoided until computed tomography has been undertaken.

Humans↗
PubMed1995

Lymphocyte subset counts in skin puncture and venous blood compared.

To determine whether skin puncture blood can be used reliably for CD4 lymphocyte counts, the numbers of the major subsets of lymphocytes were assessed in paired venous and skin puncture blood samples from 22 children and 10 adults. Paired values were highly correlated, with skin puncture values being about 7% higher than venous values for each cell type. Differences were of borderline statistical significance for total lymphocytes and for each subset except CD3+ CD8+ T lymphocytes. Nevertheless, the magnitude of the differences was small and unlikely to be of clinical importance, and it seems that skin puncture samples may be preferable for CD4 counts in children or adults with difficult venous access.

Acute Disease↗
PubMed1997

Dural puncture and activated protein C resistance: risk factors for cerebral venous sinus thrombosis.

OBJECTIVES: Dural puncture is regarded a safe procedure when contraindications are carefully excluded and has so far not been recognised as a risk factor for cerebral venous sinus thrombosis (CVST). Five patients are described with CVST after dural puncture in the presence of additional risk factors. METHODS: In four out of five patients complete investigations for thrombophilia were performed at least one month after withdrawal of oral anticoagulation. RESULTS: In three out of four patients tested, activated protein C (APC) resistance due to heterozygous coagulation factor V R506Q mutation (factor V Leiden) was found. One patient was using oral contraceptives as a circumstantial risk factor and three had had spinal anaesthesia for surgical procedures. Family history of venous thromboembolism was negative in all patients. Retrospective evaluation of 66 patients with CVST disclosed that dural puncture was the fourth most common risk factor (8%) possibly contributing to thrombosis. CONCLUSION: Dural puncture may constitute an additional risk factor for CVST especially in patients with APC resistance or surgery. In such patients a thrombophilia screen is indicated.

Adult↗
PubMed1986

The use of lumbar puncture in a district general hospital.

A survey of lumbar punctures performed in adults in a district general hospital over a two year period was carried out. As well as being used for conventional, specific indications, lumbar puncture was often employed as a screening investigation in undiagnosed neurological illness. Although this was not inappropriate in patients with meningeal symptoms and signs, or patients with disordered consciousness, lumbar puncture was also used in patients with focal neurological signs. Although the dangers of lumbar puncture in these latter patients, and the fact that it is unlikely to yield information unobtainable by other investigations have been stated by many authorities, almost 20% of patients fell into this group. This suggests that these points require further emphasis.

Adult↗
PubMed1992

Is bed rest useful after diagnostic lumbar puncture?

A randomized study of 110 patients undergoing their first diagnostic lumbar puncture was performed to compare the effect of immediate mobilization with 4 hours bed rest on the incidence of post lumbar puncture headache. There was no difference between the mobile (n = 54) and bed rest (n = 56) groups in the incidence of post lumbar puncture headache (32% versus 31%, respectively). We conclude that bed rest following lumbar puncture may be an unnecessary imposition on the patient, as well as on nursing staff.

Adult↗
PubMed1995

Embolization of carotid cavernous fistula by means of direct puncture through the superior orbital fissure.

PURPOSE: To embolize carotid cavernous fistulas (CCFs) by means of transorbital puncture of the cavernous sinus (CS) and the cavernous segment of the internal carotid artery (ICA) through the superior orbital fissure. MATERIALS AND METHODS: Five patients with CCF were treated with embolization of the CS, and six were treated with embolization of both the CS and the cavernous portion of the ICA after transorbital puncture. All except one had previously undergone occlusion of the ipsilateral proximal ICA before direct transorbital puncture. RESULTS: The fistulas in these cases were all obliterated completely. Only two patients had temporary ptosis. No other remarkable complications were noted. The patent ICA on the side of the fistula in one patient remained patent after embolization. CONCLUSION: Direct transorbital puncture through the superior orbital fissure is an alternate treatment for CCF, especially when the ipsilateral ICA has been occluded.

Adult↗
PubMed2001

Factors influencing pneumothorax rate at lung biopsy: are dwell time and angle of pleural puncture contributing factors?

PURPOSE: To study factors that may influence pneumothorax and chest tube placement rate, especially needle dwell time and pleural puncture angle. MATERIALS AND METHODS: In 159 patients, 160 coaxial computed tomography (CT)-guided lung biopsies were performed. Dwell time, the time between pleural puncture and needle removal, was calculated. The smallest angle of the needle with the pleura ("needle-pleural angle") was measured. These and other variables were correlated with pneumothorax and chest tube rates. RESULTS: One hundred fifty biopsies were included. There were 58 (39%) pneumothoraces (14 noted only at CT), with eight (5%) biopsies resulting in chest tube placement. Longer dwell times (mean, 29 minutes; range, 12-66 minutes) did not correlate with pneumothoraces (P =.81). Smaller needle-pleural angles (< 80 degrees) [corrected], decreased forced expiratory volume in 1 second to vital capacity ratio (<50%), lateral pleural puncture, and lesions along fissures were associated with higher [corrected] pneumothorax rates (P <.05). Emphysema along the needle path, pulmonary function tests showing ventilatory obstruction, and lesions along fissures predisposed patients to chest tube placement (P <.05). Pleural thickening and prior surgery were associated with lower pneumothorax rates (P <.05). CONCLUSION: Longer dwell times do not correlate with pneumothorax and should not influence the decision to obtain more biopsy samples. A shallow pleural puncture angle may increase the pneumothorax rate.

Aged↗
PubMed1996

Long-term follow-up of tracheoesophageal puncture results.

Since its introduction by Blom and Singer in 1980, tracheoesophageal puncture with a voice prosthesis has become the most frequently recommended choice for speech rehabilitation of total laryngectomies. Many studies have reviewed the initial speech acquisition success rates following tracheoesophageal puncture; however, long-term follow-up in these initial successes has been lacking. In addition, factors predictive of long-term success with tracheoesophageal speech have not been defined. Over a 10-year period, we retrospectively reviewed all total laryngectomy patients, including those who have undergone primary or secondary tracheoesophageal puncture, at the University of Illinois Hospital and Clinics and the Westside Veterans Administration Hospitals. Survival in the total laryngectomy cohort of 202 patients ranged from 35% to 50%. Forty of these patients underwent tracheoesophageal puncture, in whom survival was 75%. Short-term success with tracheoesophageal speech was approximately 70% for our patients, while long-term success was achieved in 66%. Despite low socioeconomic status and relatively high alcoholism rates, successful maintenance of tracheoesophageal speech was achieved in the majority of cases. Tracheoesophageal speech should therefore be considered as a primary method of vocal rehabilitation in all patients undergoing total laryngectomy.

Adult↗
PubMed1984

Tracheoesophageal puncture for voice restoration: modification of the Blom-Singer technique.

We have used a modification of the Blom-Singer technique in our last 24 tracheoesophageal punctures, performed on 20 patients. At the time of puncture a surgical stent with an indwelling Dacron polyester suture is placed to form the fistula. Forty-eight to 72 hours later the stent is backed out of the puncture site but the suture is allowed to remain. The Blom-Singer duckbill prosthesis is fitted and taped in the routine fashion. The suture is left to traverse the tracheoesophageal tract until the time of discharge, when it is removed. At discharge the patient is given a Silastic dilator, to be used if the puncture site becomes too small to allow for insertion of the duckbill prosthesis. Seventeen of the 20 patients in this group obtained good voice. Six operations would have been failures because of the loss of the patient's prosthesis in the immediate postoperative period if the modified technique had not been used.

Esophagus↗
PubMedDate not supplied

Central nervous system involvement in non-Hodgkin's lymphomas: value of lumbar puncture as initial staging procedure.

To identify the subgroups of patients with malignant non-Hodgkin's lymphomas who might benefit from prophylactic therapy to prevent CNS relapse, lumbar puncture was routinely performed among the other staging procedures from January 1976 to October 1979 in 76 patients with diffuse lymphomas. The study also takes into consideration 32 patients who came to out observation during the same period and who were studied with lumbar puncture performed in case of suspicious CNS involvement or along with other procedures during restaging the acquire further information on prognostic factors related to CNS involvement. Cerebrospinal fluid (CSF) cytology was positive in 3 of 76 patients studied with initial lumbar puncture; however, only 2 (2.6%) were asymptomatic. Within the group of 32 patients in whom lumbar puncture was performed during the course of the disease, all 17 patients with suspicious CNS involvement were found to have a positive CSF cytology with the exception of 1 patients with multiple focal involvement of brain parenchyma. Clinical signs of CNS involvement associated with CNS positivity were all found in patients with diffuse histology. In these patients bone marrow invasion or a leukemic picture was frequently associated with CNS relapse. In 47% of patients CNS disease developed while they were in clinical remission. In this series cranio-spinal irradiation associated with intrathecal chemotherapy provided the best results, even in survival was not primarily dependent upon the control of their CNS involvement but related to progressive systemic disease in other sites. On the basis of the clinico-prognostic parameters examined, some guidelines for early diagnosis and treatment of CNS lymphomatous involvement are provided.

Bone Marrow↗