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PubMedDate not supplied

Anterior stromal puncture for bullous keratopathy.

BACKGROUND AND OBJECTIVE: To evaluate the effects of anterior stromal punctures on the symptomatic relief of patients with bullous keratopathy considered ineligible for penetrating keratoplasty. PATIENTS AND METHODS: Five eyes of five patients with bullous keratopathy who had intolerable pain, tearing, and photophobia and were ineligible for penetrating keratoplasty were enrolled. Under slit-lamp magnification, anterior stromal punctures were applied directly at the bullae with a 24-gauge needle. Supplementary anterior stromal punctures were applied for recurrent bullae, if any, during the follow-up. The condition of the cornea was recorded by taking photographs. Pain and discomfort were subjectively evaluated. RESULTS: A significant reduction in pain and tearing was achieved. Epithelial and subepithelial fibrosis with scarred small bullae formation was observed during the follow-up. CONCLUSIONS: The anterior stromal puncture is an effective and low-cost method to relieve troublesome symptoms in patients with bullous keratopathy who are not eligible for corneal grafts.

Aged↗
PubMed1992

Laparoscopic supracervical hysterectomy using a single-umbilical puncture (mini-laparoscopy).

Laparoscopic supracervical hysterectomy with bilateral salpingo-oophorectomy utilizing the single-puncture technique (mini-laparoscopy) is presented here for the first time. The surgical outcome of four patients in whom this minimally invasive approach was employed demonstrates the effectiveness of the single-puncture technique as an alternative to the currently used multiple-puncture method for hysterectomy. Laparoscopic supracervical hysterectomy with removal of the uterus and adnexa through the umbilical puncture site is an effective alternative for patients with a healthy cervix, no associated genital prolapse and moderate uterine enlargement. Advantages of this new modality include reduced blood loss and operating time, and the decreased possibility of surgical injury to the ureters, bladder and bowels. The risk of development of malignancy in the retained stump is almost eliminated by the laparoscopic removal of the upper endocervical canal and cauterization of the lower endocervical canal and exocervix.

Adult↗
PubMed2003

Calculating lumbar puncture depth in children.

Lumbar puncture was performed in 195 children and the depth of needle was recorded. Our results show that the depth of lumbar puncture necessary to obtain uncontaminated cerebrospinal fluid correlates best with the child's weight. The simple formula: mean depth of insertion (cm) = 1.3 + 0.07 x body weight (kg), can be used to estimate the depth of lumbar puncture of children older than 3 months. The depths of lumbar puncture of children younger than 3 months are mostly 1.0-1.5 cm.

Adolescent↗
PubMed2004

[Prophylactic bedrest against post-lumbar puncture headache should not be routinely used in all patients].

Headache after lumbar puncture (PPH) is a common clinical problem, and occurs more frequently in patients with prepuncture headache. Bedrest after extraction of the needle has been recommended as prophylaxis for over a century. In a nation-wide survey, it was found that a majority of Swedish clinics kept all patients in a recumbent position for 30-90 minutes or longer. Many patients find enforced bedrest after lumbar puncture disagreeable, and every second person does not follow the recommendation. There is no good evidence from randomised trials to suggest that routine bedrest after dural puncture is beneficial. On the contrary, there are data in support of an increase of PPH after prolonged recumbency. Presumably, all cases should not be handled similarly. Based on present knowledge, it is suggested that patients free of headache during the last week before lumbal puncture are to be mobilised immediately.

Evidence-Based Medicine↗
PubMed1992

[New puncture technique for TIPSS (transjugular intrahepatic portosystemic stent shunt)].

To establish a safer puncture method for TIPSS (Transjugular Intrahepatic Portosystemic Stent Shunt), we developed a new percutaneous puncture technique to penetrate portal and hepatic vein trans-hepatically under ultrasonography (US technique). Experimentally we compared this technique with conventional transjugular technique puncturing portal vein through hepatic vein using Ross needle (Ross Needle technique). Success rate is 100% in US technique and 50% in Ross needle technique. Seven complication including intraperitoneal bleeding occurred in Ross needle technique, but no complication in US technique. Conclusively, US technique is a safer and more reliable method than that using Ross needle in the puncture method for TIPSS.

Animals↗
PubMed2006

[Maxillary puncture: endoscopic assessment].

Frequency of the injury of the nasolacrimal duct ostium during maxillary puncture through the lower nasal passage was estimated endoscopically. Changes in the maxillary medial wall during the puncture were also studied. Anatomic features of the ostiomeatal complex which may contribute to development of chronic inflammation were determined. Forty one sinuses of 27 deceased middle-aged patients were examined within 24 hours after death. One third of patients in a random population had chronic maxillary inflammation caused by structural anomalies in the ostiomeatal complex. Half of the punctures were made with severe traumas of the nasolacrimal duct ostium. Natural anastomosis of the sinus did not function in about 20% cases. Accessory anastomosis in the posterior fontanelle was registered in 12.2% cases. The posterior fontanelle broke during sinus lavage in 3 cases. Indications for maxillary puncture in acute and chronic maxillary sinusitis should be considered much more carefully in the presence of stable alterations in the ostiomeatal complex and block of the natural anastomosis.

Aged↗
PubMed1991

[Percutaneous puncture and drainage under ultrasonic control of pancreatic pseudocysts].

Eighty-seven pancreatic pseudocysts have been treated with a single or repeated puncture, which was or was not followed by percutaneous drainage. When the diameter of the cyst was smaller than 5 cm, it was healed in 83.3% of all cases. When the size of the cysts ranged from 6 to 10 cm, puncture alone allowed curing them in 57.1% of all cases, otherwise it had to be completed by drainage. On the other hand, puncture alone was not sufficient for cysts with a diameter exceeding 10 cm, and an associated suction or surgical drainage was required. In the light of this experience, we can bring out the respective indications of single and multiple puncture and of percutaneous drainage, while taking account both of the size and of the etiological and clinicopathological features of the pseudocysts. In addition, this study allows assessing the incidence of the complications associated to this type of treatment.

Adolescent↗
PubMed1991

Our experiences with the management of pyogenic liver abscesses by percutaneous transhepatic puncture and permanent drainage guided by computed tomography.

Thirty-three patients with pyogenic liver abscess were treated by percutaneous transhepatic puncture or permanent drainage between the period of 1, January 1985 and 31, December 1990. The closed puncture or drainage resulted in the complete recovery of 26 patients (26/33 = 78.8%). Surgical intervention was made 6 +/- 5 days following closed drainage in 7 cases (7/33 = 21.2%). After percutaneous intervention complications ensued in four patients (4/33 = 12.1%). One patient died (1/33 = 3%). Solitary abscess occurred in 24, while multiple in 9 patients. Based on the authors' experiences, they consider the closed percutaneous puncture, or drainage guided by computed tomography--provided that proper shills and facilities are available--them does not enable in all cases the precise preoperative diagnosis even despite its richness of detail. In order to reduce uncertainties and to establish an accurate diagnosis, Herbert et al., McCorrcel et al. and Perera et al. proposed three criteria to be met before establishing the diagnosis of pyogenic liver abscess. According to the authors the conditions for accepting these criteria can be summarized as follows: 1. On the US examination of the liver, echo-free or echo-poor regions can be seen with increased background echoes. CT verifies an inhomogeneous, circumscribed or irregular-shaped, blurred focus of finely deformed contours being hypodense in contrast with the environment. On administration of contrast medium, the change is surrounded by a hyperdense border, and other causes for the above change can be excluded. 2. Verification of the presence of pus (by percutaneous puncture or surgery) from the liver biopsy. 3. The negative result of serological tests characteristic of amoebic infection. CT and US examinations have opened up new vistas not only in establishing diagnosis but also in the management of the disease. The closed percutaneous and effective method in the management of liver abscesses.

Adolescent↗
PubMed1991

[Headache following spinal puncture: treatment with epidural blood patch in a 7-year-old patient].

Lumbar puncture is frequently used for diagnostic and therapeutic purposes in children. Theoretically, this group of patients should have high rates of post lumbar puncture headache. However, the scant available literature points to a surprisingly low incidence and an apparently mild course. We present a 7 year-old patient with a severe post lumbar puncture headache successfully treated with an epidural blood patch. To our knowledge, this has not been reported in children younger than 10 years. We believe this procedure should be considered in pediatric patients with post lumbar puncture headache.

Blood Patch, Epidural↗
PubMed1990

[Improvement of the transthoracic method of puncture sanitation in complex treatment of lung abscess].

A method of transthoracic puncture sanitation treatment of the cavity of a lung abscess with the use of a needle of an original design and the proteolytic enzyme karipazyme (0.5% solution) is suggested. Fifty-two patients with abscess of the lung (main group) were treated by this method, 46 (88.4 +/- 4.4%) were cured, in 5 (9.6 +/- 4.1%) transformation to a chronic abscess occurred, one patient (1.9 +/- 1.7%) died. Transthoracic puncture with a commonly used needle and administration of antibiotics into the cavity of the abscess were performed in 57 patients (control group). Thirty-eight patients (66.7 +/- 9%; p less than 0.05) recovered, chronic abscess formed in 14 patients (27.6 +/- 5.9; p less than 0.05), 5 patients (8.7 +/- 3.7%) died. The duration of treatment of patients in the main group was reduced by 16.1 days. The method of skin coloured liquid-crystal thermography was employed in 28 patients to determine the optimal point for puncturing the abscess, as the result of which complications were avoided and the number of failures in puncture of the lung destruction cavity reduced by half.

Anti-Bacterial Agents↗
PubMed1990

The role of the lumbar puncture in the admission sepsis evaluation of the premature infant.

Premature infants with respiratory distress commonly receive evaluation for sepsis, including a lumbar puncture, within a short time after admission to a neonatal intensive care unit. We questioned the use of the lumbar puncture during the early sepsis evaluation, and since 1979, have omitted this procedure as part of the initial evaluation for sepsis (within 6 hours of birth) of premature infants. We monitored this policy to detect any change in the incidence of meningitis, and now report results accumulated over a 7-year period. From 1979 to 1986, 1390 inborn premature infants of 34 weeks' gestation or less were evaluated for early sepsis within 6 hours of birth. Thirty-two infants (2.3%) were diagnosed with sepsis. Fifteen of these infants died in the first 24 hours of life. Meningitis was not demonstrated by autopsy evaluation. The surviving 17 infants diagnosed with sepsis did not have meningitis. One hundred twenty-three infants whose initial blood cultures were negative developed infection later in their hospital course. Eleven of these 123 infants had infections with perinatally acquired organisms; two had group B streptococcus (GBS) meningitis. Their cases were not compatible with missed meningitis. The remaining 112 infants developed nosocomial infections of which 38.3% developed meningitis without associated bacteremia. These results suggest that the omission of the lumbar puncture in the early sepsis evaluation of the premature infant did not result in any missed meningitis and spared many infants the procedure shortly after birth. The lumbar puncture, however, continues to be vital in the assessment of late infections of the neonate.

Bacteria↗
PubMed1989

[The clinical value of percutaneous puncture of pancreatic cysts guided by ultrasound].

This article reported 11 cases of percutaneous puncture of pancreatic cysts guided by ultrasound. All were successfully punctured. The clinical value, indication and the procedure were discussed. Percutaneous puncture is not only valuable for diagnosis of pancreatic cyst, but also for therapy. Of ten cases treated by puncture aspiration, two cases with two cysts were followed for 2.5 years and 5.5 years respectively without recurrence of the cyst; in another case, the cyst was reduced to 62% of its original size after 4 years.

Adult↗
PubMed1985

[Value of guided puncture and needle biopsy for the diagnosis of localized bone lesions].

The results of 20 puncture-biopsies and 43 needle-biopsies performed under local anaesthesia and guided towards a localized bone lesion under a fluoroscopic TV screen are reported. Malignancy was confirmed in 31 out of 36 cancerous bone lesions (83%). Metastases were demonstrated in 24/25 cases (96%) and malignant lymphocytic or plasmocytic lesions in 6/6 cases. There were no false-positive results with benign lesions. However, an accurate aetiological diagnosis was supplied by puncture- or needle-biopsy in only 1/5 cases of primary malignant tumour and in 1/6 cases of benign tumour. Guided puncture- or needle-biopsy seems to be particularly useful to distinguish between benign and malignant lesions, notably when bone metastasis is suspected. The technique can then be applied to those cases where puncture-biopsy of the posterior iliac crest is negative or even as first choice procedure if the bone lesion is not readily accessible.

Adult↗
PubMed1986

[Technic for digitalized angiography of the legs by unilateral femoral artery puncture and programmed displacement of the examination table. Apropos of 56 cases].

The authors describe a technique for digital subtraction angiography of vessels of the legs, performed in 56 patients for suspicion or control of peripheral vascular disease. Owing to an unilateral femoral arterial puncture and a programmed moving of the table top, a subtraction arterial mapping of the two legs is obtained with only two injections of contrast medium. On the side of the puncture the arterial opacification is always very satisfactory. On the other side opacified by reflux the popliteotibial region is visualized in 95% of cases. We had no complication with iodine or arterial puncture. Our technique is then characterized by its simplicity and a small trauma owing to the unilateral puncture and the reduction of contrast medium injections.

Adult↗
PubMed1986

[Meningitis following lumbar puncture].

Two young children underwent lumbar puncture because of fever and convulsions. After CSF examination had initially yielded no pathological findings, both children developed purulent meningitis. Second puncture and start of antibiotic therapy had been delayed, since CSF re-examination had only been performed two days after the first puncture. The literature reports on 23 similar cases in children. Whenever the clinical course suggests meningitis, one should therefore not hesitate to carry out a second lumbar puncture, even if CSF examination had yielded no pathological findings a short time ago.

Female↗
PubMed1978

[Clinical and paraclinical changes in cattle with traumatic pericarditis before and after pericardial puncture].

A puncture of the pericardium has been performed on cows with a traumatic pericarditis. The clinical status has been taken and paraclinical investigations prior to and after the puncture have been carried out. Following a puncture of the pericardium, up to the 12th hour, the movements of the rumen decrease or entirely disappear, and are restored again later, while respiratory movements and the heart activity become ever more frequent. A leucocytosis occurs without a trend towards a return to the initial level as well as neutrophilia with a nuclear left-shifting to metamyelocytes. The clinical and paraclinical changes in cattle with a traumatic pericarditis, after a puncture of the pericardium, point to a deterioration in the condition and a possible exitus.

Animals↗
PubMed1977

[Significance of suprapubic puncture of the bladder in routine diagnosis].

516 urines of 258 persons urologically ill with and without infection of the urinary tract collected in routine work were comparatively examined. Only such patients were taken into consideration who did not undergo an antibiotic therapy or who had made a pause of at least 3 days in the antibiotic therapy. The collection of the urine was carried out by means of puncture of the bladder as well as according to the mid-stream principle or by means of catheterisation. The qualitative and quantitative diagnostics of germs did not result in a significantly increased exactness of the examined urines collected by puncture of the bladder compared with the catheter or mid-stream urines. Therefore, the collection of urine by means of puncture of the bladder should be reserved for aimed indications and should not be taken into routine work. The catheter and mid-stream method is further entitled as screening method. Above all the falsely positive results condition the inexactness of this method. But also the urines collected by puncture of the bladder showed contaminations which account for our critical estimation.

Adult↗
PubMed1983

Epidural abscess and vertebral osteomyelitis following serial lumbar punctures.

Lumbar epidural abscess and vertebral osteomyelitis were diagnosed in a 3-month-old infant, born prematurely, who had had repeated lumbar punctures for the treatment of posthemorrhagic hydrocephalus. Staphylococcus aureus was the causative organism. Successful treatment was achieved with 6 weeks of intravenous antibiotics without surgical drainage. Infectious complications of lumbar punctures are rare, but may occur when multiple punctures are attempted in small premature infants whose subarachnoid space contains large amounts of blood. Infection can be introduced directly by a contaminated spinal needle, or trauma to the tissues with bleeding can create a favorable site for bacterial adherence and multiplication. Posthemorrhagic ventricular dilation often resolves spontaneously and serial lumbar punctures should be used to treat this condition only when CSF flow is easy to establish and maintain.

Abscess↗