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PubMed1982

[Pericardial puncture under the ultrasonic cardiotomographic guidance: application to pericardial effusion].

Pericardial puncture drainage was attempted in five patients with pericardial effusion under the guidance of real time two-dimensional echocardiography (ultrasonic cardiotomography). The needle fixed to the scanner probe was inserted from the anterior chest wall under the observation of ultrasound images. After the needle was placed into the pericardial space, then the drainage catheter was introduced according to the Seldinger technique. The image of the needle should be appropriately monitored from the site of puncture as near as possible because the pericardium is so close to the anterior chest wall. Both mechanical and linear sector scanners were used in this study, and linear type was proved to be useful for this purpose. It was concluded that the pericardial puncture under the guidance of ultrasonic cardiotomography is safer and reliable compared to the conventional blind puncture technique.

Adult↗

PubMed1981

Neonatal osteomyelitis of the os calcis: a complication of repeated heel punctures.

Neonatal osteomyelitis has been frequently reported, but only rarely as a complication of repeated heel punctures. The need for constant monitoring of premature newborns and those having low birthweight and serious deformities necessitates repeated blood samples, usually obtained by heel puncture. Os calcis osteomyelitis occurred in three patients, possibly secondary to heel puncture. A swollen lower extremity in newborns should alert clinicians to the possibility of infection originating in the heel. Treatment involves adequate doses of appropriate antibiotics, but if the infection does not respond within 48 hours, then surgical drainage is indicated. Secondary extension to more proximal areas can and may occur with catastrophic consequences. Orthopedic surgeons should help other physicians become aware that repeated heel punctures may cause os calcis osteomyelitis and that they should be avoided.

Calcaneus↗

PubMed1981

[Pathogenesis of headache following lumbar puncture].

Results of clinical observations of 52 patients in whom diagnostic lumbar punctures were performed for various organic diseases of the nervous system are presented. The work was aimed at finding out, whether the rather frequent post-puncture headaches depend on the tone of the cerebral vessels and their blood content. For this purpose rheoencephalography was used. An analysis of the rheoencephalograms recorded before and after the lumbar punctures in 15 patients with and in 35 patients without the post-puncture headaches showed that the headaches did not depend on the initial tone of the cerebral vessels and their blood content. Hence, these headaches are not due to vasomotor disturbances. Of decisive importance in their pathogenesis is, probably, intracranial fluid hypotension.

Adolescent↗

PubMed1994

[Femoral arteriovenous fistulas after vascular puncture for hemodialysis].

From 1978 to 1991 we observed 10 patients who developed femoral arteriovenous fistula after venous puncture for hemodialysis. The fistula most often appeared after several punctures, but 3 developed after a single puncture. Diagnosis was made on the basis of local observation and auscultation of the vessel (bruit + thrill n = 10, hematoma n = 4, pulsatile mass n = 1). Two patients had arteriography and 2 had echo-doppler. Arteriography was not required for diagnosis (since clinical signs were sufficient), or for treatment, since echo-doppler and surgery indicated the location of the fistula. Five patients underwent surgery. In all cases, continuity of the main vessels of the lower member was maintained or reestablished during surgery. Surgery is mandatory for high flow rate. Such fistulas cannot be used and can cause cardiac failure in patient with another fistula for hemodialysis. Surgery should not be undertaken too early because of the possibility of spontaneous clotting (particularity if echo-doppler shows low flow rate), and to allow organization of the lesions and easier dissection. Auscultation of the vessel should be a routine procedure after any femoral vein puncture in order that this complication not be overlooked.

Adult↗

PubMed1994

[Percutaneous renal cyst puncture and ethanol instillation].

Ultrasound-guided renal cyst puncture was performed on 26 renal cysts in 24 patients. Puncture of the renal cyst was performed with a 6 Fr single J catheter on a 19.5 gauge needle. In 7 cases, only aspiration of the cyst fluid was carried out. In the other cases, renal cysts were instillated with 95% ethanol as a sclerosing agent to prevent recurrence. All cases were followed up by ultrasound or computerized tomographic (CT) scan for 1 to 64 months. The ethanol-instillated renal cysts were more markedly reduced (average reduction rate: 90.9 +/- 14.7%) than the non-instillated cysts (average reduction rate 28.9 +/- 12.6%). After puncture of the renal cyst, pain and microhematuria disappeared in most patients who had received ethanol instillation. Minor complications such as pain and low grade fever were observed in some cases in this series, but not major complication. Thus, ultrasound-guided renal cyst puncture with 95% ethanol instillation is a useful procedure for the treatment of renal cysts.

Adult↗

PubMedDate not supplied

A loss-of-resistance-to-negative-pressure test for subarachnoid puncture with narrow-gauge needles.

BACKGROUND AND OBJECTIVES: Approximately 5-10% of attempted myelograms are spoiled by partial subdural injection. Similar spillage of local anesthetics may underlie the wide variability of segmental spread reported for spinal anesthesia. A technique of applied negative pressure to avoid accidental subdural injection and to facilitate subarachnoid puncture with narrow gauge needles is described. METHODS: Hydraulic circuitry was designed to measure saline flow rates through spinal needles at hub-to-tip differential pressures of 55 mm Hg and 650 mm Hg. A model of dura and arachnoid membranes was constructed to demonstrate the effects of applied negative pressure on the subdural space during the passage of Quincke-tip and pencil-point needles. Cisternal puncture in 38 dogs and thoracic or lumbar subarachnoid puncture in 680 patients were performed using applied negative pressure to the needle hub. RESULTS: A sustained vacuum of -650 mm Hg at the hub of air-filled spinal needles was transmitted beyond the tip but fell to zero at the tip as the shaft filled with saline. Flow rates through the Quincke needles, ranging from 22-gauge to 29-gauge, rose 22- to 33-fold when a vacuum of -650 mm Hg was applied at the hub. Model dura and arachnoid membranes were separated by air-filled tips at atmospheric pressure but were juxtaposed by negative pressure applied to the hub. CONCLUSIONS: Negative pressure applied to the needle hub is transmitted to the tip without decrement in air-filled needles but not in fluid-filled needles. Clinical application of this principle by exertion of strong negative pressure at the hub during needle advancement facilitates rapid identification of cerebrospinal fluid, avoids unintentional subdural injection of local anesthetics or contrast media, and increases the safety of subarachnoid punctures above the termination of the spinal cord.

Animals↗

PubMed1993

[Antegrade puncture of the superficial femoral artery: a pilot project].

Antegrade puncture of the femoral artery is often the first step in angioplasty or thrombolysis of the lower limb. Because of presumed complications, mostly from anecdotal literature, the common femoral artery is the preferred site of entry. From there, selective catheterization of the superficial femoral artery can be performed. This two-step procedure is sometimes long and difficult for both the patient and the radiologist. To improve the ease and the rapidity of this procedure, the author performed direct antegrade puncture of the superficial femoral artery during 25 consecutive antegrade approaches. The only local complication was hematoma, which developed in two patients but disappeared spontaneously. Aggravating factors were the size of the catheters used and fibrinolytic therapy in one of the affected patients. The results of this pilot study suggest strongly that direct antegrade puncture of the superficial femoral artery is safer than might be expected from the literature, which deals primarily with retrograde puncture. This approach must now be systematically compared with the "classic" common femoral artery approach.

Aged↗

PubMedDate not supplied

An anatomic study of the effects of dural puncture with different spinal needles.

BACKGROUND AND OBJECTIVES: The purpose of this study is to evaluate the effects of puncture of lumbar dura mater with needles of different sizes and with bevels of different shapes. METHODS: After removal, the dura was punctured with different needles (22-, 25-, 27-, and 29-gauge Quincke, 24-gauge Sprotte, 22-gauge Whitacre, and 18-gauge Tuohy needles) and observed by stereomicroscope to examine the gross morphology. Histologic features were observed by light microscope using frozen and fixed samples stained with hematoxylin and eosin or specific methods (Masson and Weigert) to evidence elastic or collagen fibers. RESULTS: Puncture hole size was proportional to the size of the needle used. Quincke type needles determined oval or ellipsoidal holes; pencil-point needles determined more rounded holes. Dural retraction determined a reduction of the holes in all cases. Histologic examination revealed an irregular border of the hole, with sectioned as well as compressed fibers. The pattern of compressed but not sectioned fibers was observed more frequently in the samples punctured by pencil-point needles. CONCLUSIONS: This study confirms that the arrangement of dural fibers is not as uniform as previously thought. Histologic findings confirm the current opinion that pencil-point needles may be less traumatic than Quincke-type needles. The direction of the bevel of the needle does not appear to have great importance in determining the shape of the hole.

Aged↗

PubMed1996

[A case of spinal epidermoid caused by lumbar punctures].

A case of spinal epidermoid caused by lumbar punctures is reported. The 50-year-old man, who had been diagnosed as having poliomyelitis and who had been treated with lumbar puncture 24 times when he was 1 year old, came to our clinic complaining of gradual worsening of atrophy and weakness in his right leg during the last 10 years. Neuroradiologically, intraspinal tumor with calcification was detected in the lumbar region and partial removal of the tumor was performed. Pathological diagnosis was that it was epidermoid. During frequent lumbar puncture at the age of 1, some small skin grafts had been implanted intrathecally and we concluded that, changing its original nature, it had grown slowly to become epidermoid. We want to emphasize especially here that, when we performe lumbar puncture, we should, as far as possible, use a small needle with stilette so as not to induce future spinal epidermoid.

Epidermal Cyst↗

PubMedDate not supplied

Late recurrence of postdural puncture headache.

BACKGROUND AND OBJECTIVES: Postdural puncture headache can recur following an epidural blood patch but usually does so within the first week. However, a late recurrence was encountered in a 31-year-old woman with probable lupus vasculitis. METHODS: The patient underwent a diagnostic lumbar puncture and suffered a postdural puncture headache. She was treated with an epidural blood patch and had complete resolution of her headache. Five weeks later, she suffered a sudden recurrence of an identical headache and underwent a repeat epidural blood patch. RESULTS: The second headache, like the first, was immediately and completely resolved. CONCLUSIONS: A review of risk factors for postdural puncture headache and the role of an epidural blood patch suggests a possible explanation for the late recurrence in this case.

Adult↗

PubMed1997

Comparison of puncture versus vasotomy techniques for vasography in an animal model.

PURPOSE: We determine the adverse effects of 2 different techniques of vasography in an animal model. MATERIALS AND METHODS: Unilateral vasography was performed by a direct puncture technique with a lymphangiogram needle or through a partial thickness vasostomy technique in 2 groups of 10 adults Lewis rats using nonionic contrast medium mixed with methylene blue. Each rat had a contralateral vasectomy. A complete vasogram was confirmed by visualization of colored dye in the bladder. An additional group of 5 animals with unilateral vasectomy alone served as controls. The adverse effects of these 2 techniques were assessed by performing mating studies at 2 and 4 months after vasography. In vitro flow through the vas deferens, sperm granuloma formation and histology of the vas deferens at the vasography site were evaluated at sacrifice 5 months after vasography. RESULTS: The fertility of the 3 groups, as measured by the mean number of uterine implantation sites, was not significantly different at the 2 and 4-month breeding periods. In addition, we observed no significant decrease in the fertility of the 3 groups with time. Complete vasal obstruction was noted at sacrifice in 2 rats (20%) in the vasostomy group and none in the puncture or control group (p = 0.476). The mean in vitro flow rates through the vasa of the puncture and vasostomy vasography groups were significantly lower than those in controls (p < 0.05) but not different from each other. The sperm granuloma formation rate was similar among the 3 groups. CONCLUSIONS: Our results demonstrate that both vasography techniques have a measurable adverse effect on vasal flow rates and a potential adverse effect on fertility. The direct puncture method had a slightly lower complication rate than the partial thickness vasostomy method and it may be the preferable technique for the inexperienced microsurgeon.

Animals↗

PubMedDate not supplied

[Hearing loss secondary to lumbar puncture].

Hearing complaints have been described in patients after lumbar puncture, although other symptoms like headache, nausea, and dizziness can easily obscure hearing disorders. Reduced cerebrospinal fluid pressure after lumbar puncture may explain the origin of this vestibulocochlear dysfunction. Two cases of hearing loss and tinnitus that appeared hours after otherwise uncomplicated diagnostic spinal puncture are reported. The pure tone audiogram showed a 40-50 dB bilateral sensorial hearing loss in the lower frequencies. Hearing recovered and tinnitus disappeared entirely within 7-10 days. Since permanent hearing loss has been reported after diagnostic or therapeutic lumbar puncture, we should be aware of the possibility of this adverse effect.

Adult↗

PubMed1987

Diagnostic reliability of combined physical examination, mammography, and fine-needle puncture ("triple-test") in breast tumors. A prospective study.

A prospective study of 622 consecutively registered patients with 650 breast tumors was performed to appraise the reliability of combined physical examination, mammography, and fine-needle puncture (triple test) in the preoperative diagnosis of such tumors. All malignant as well as benign test results were confirmed by subsequent histologic examination. The diagnostic accuracy of the triple test at benign changes is comparable to that of histologic examination, but participation of experienced radiologists and cytologists as well as persons skilled in fine-needle puncture is required. Twenty-eight percent of the planned excisional biopsies were made superfluous by the fine-needle puncture, which immediately revealed the tumor as a cyst, abscess, or hematoma. For this reason, too, fine-needle puncture is recommended as a routine procedure.

Biopsy, Needle↗

PubMed1996

Randomized trial of blunt-tipped versus cutting needles to reduce glove puncture during mass closure of the abdomen.

Eighty-five consecutive patients were randomized to undergo mass closure of the abdomen with no. 1 polydioxanone mounted on either a blunt-tipped (n = 46) or cutting (n = 39) needle. Gloves were changed before closure and tested for perforation afterwards using standard air or water techniques. Fourteen pairs of gloves were punctured when using a cutting needle, and three pairs when a blunt-tipped needle was used. The majority of punctures were to the non-dominant glove. The surgeon was aware of the puncture in eight of the 14 instances involving a sharp needle and in one of the three involving a blunt-tipped needle. Blunt-tipped needles, while not eliminating the risk, significantly reduced the incidence of surgical glove puncture (P < 0.001, Fisher's exact test). The use of cutting needles for abdominal closure should be abandoned.

Abdomen↗

PubMed1987

[Effect of forced respiration on the stress on puncture channels of sutures in transverse laparotomies of the upper abdomen; experimental studies in the anesthesized dog].

In 11 mongrel dogs in propiophenylpromazine-pentobarbital-anaesthesia the influence of forced respiration on the load of puncture channels of a suture was investigated. For this horizontal suture in the upper abdominal wall, threads No. 3 USP and round needles No. ECT-4 were used. The experiments were carried out in supine position with stretched hindlegs, in supine position with relaxed hindlegs, in lateral position, and in hanging abdominal position. Measurements were performed with a selfconstructed resistance strain gauge element. Rising forced respiration pressure increased the inspiratory load of puncture channels, but there were no significant differences between spontaneous breathing and forced respiration with pressure of 10 cm H2O. In contrary to this there were highly significant differences between spontaneous breathing and forced respiration with pressure of 20 and 30 cm H2O (multiple variance analysis). For instance the load during forced respiration with a pressure of 30 cm H2O in supine position with relaxed hindlegs rose about 67% above pressure values of spontaneous breathing. It could be shown that the expiratory load in the puncture channels was not influenced by forced respiration pressure, but depended on the body position; in dogs it was minimal in side position (45-48 g), higher in supine position with relaxed hindlegs (67-71 g), even higher in supine position with stretched hindlegs (88-92 g), and maximal in hanging abdominal position (109-113 g). By this investigation the increase of load in the puncture channels during forced respiration with pressures of 20 and 30 cm H2O was quantified.

Abdomen↗

PubMed1988

[The Huber needle as a special cannula for the puncture of implanted ports and pumps--a mistake in multiple variations].

Huber-point needles, which are thought to be noncoring, are usually recommended for puncture of implanted drug-delivery devices, such as ports and pumps. Nevertheless, we found occlusion by silicone chips deriving from the silicone inlet septum to be a major technical complication. Electron microscopic investigations demonstrated substantial loss of material from the port membrane after repeated puncture with this type of needle. During an in vitro test, multiple puncture with Huber-type cannulas led to a pressure-dependent leakage of a port after only 150 to 750 insertions of a needle. In addition, the forces necessary for puncture or for withdrawal of the needle were increased with Huber-point needles, possibly due to a coring effect. Another disadvantage of the available port needles is the formation of a hook at the tip, which may lead to additional lesion of the port or pump membrane. In our opinion, resterilization of Huber needles, recommended by the manufactures, is not advisable, because it is well known that safe sterilization of small lumina, e.g., the lumen of the needle, is impossible.

Catheterization↗

PubMed1995

Cervical dural puncture and lumbar extradural blood patch.

The authors report the successful treatment of post-dural puncture headache, consequent to a cervical dural puncture, with a lumbar extradural blood patch. The increase in intracranial pressure generated by the injection of autologous blood in the extradural space seems to be the likely mechanism for the prompt relief of post-dural puncture headache. We conclude that extradural injection of autologous blood at the same level of the dural puncture may not be necessary.

Adult↗

PubMed2004

Bilateral sixth cranial nerve palsy after unintentional dural puncture.

PURPOSE: Bilateral sixth nerve palsy is a known though uncommon complication following dural puncture. The recommended treatment consists of hydration and alternate monocular occlusion. The value and the timing of an epidural blood patch (EBP) for sixth nerve palsy remains controversial as some authors have demonstrated benefits in performing an EBP early in course of the nerve palsy whereas others have not found any advantage when an EBP was performed later. CLINICAL FEATURES: A 40-yr-old woman developed bilateral sixth nerve palsy ten days after an unintentional dural puncture. An EBP was done within 24 hr after the onset of the symptoms and immediate improvement of the diplopia was noted by the patient and confirmed by an ophthalmologist. Complete resolution of the diplopia occurred 36 days after the dural puncture. CONCLUSION: Blood patching within 24 hr of the onset of diplopia may be a reasonable treatment for ocular nerve palsy as it relieved the postdural puncture headache and produced partial improvement of the diplopia.

Abdominal Pain↗