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At least 577 records · Page 32Linked to original sources
PubMed2000

Dural puncture and iatrogenic pneumocephalus with subsequent transverse myelitis in a parturient.

PURPOSE: To report a case of transverse myelitis following inadvertent dural puncture and iatrogenic pneumocephalus and any possible causal relationship is explored. CLINICAL FEATURES: A 32-yr-old primigravida developed a severe headache associated with pneumocephalus following accidental dural puncture when the loss of resistance to air technique was used to locate the epidural space. She was treated with oxygen 100% to promote resorption of the air and the headache resolved. One month later she developed a sensory disturbance in her feet. Neurological examination revealed reduced sensation to cold and pain to ankle level and bilateral suppressed knee and ankle reflexes but was otherwise normal. A spinal cord lesion (epidural abscess/hematoma) was excluded with an emergency T1 and T2 weighted magnetic resonance imaging (MRI) scan of the lumbar spine. Over the next 48 hr the sensory disturbance worsened to involve her legs and waist. Examination revealed a sensory loss to waist level, reduced joint position sense and vibration sense in her lower limbs and absent knee and ankle reflexes bilaterally, but normal power in both her legs. A further full length T2 weighted MRI scan of the spine showed a small area of high signal at the level of T3 compatible with transverse myelitis. This was treated with high dose corticosteroids and her symptoms resolved over the next three months. CONCLUSION: The etiology of transverse myelitis after dural puncture in a parturient could not be identified nor could any causal link be established between the dural puncture, pneumocephalus, and subsequent transverse myelitis.

Adult↗
PubMed2002

Technical developments: use of targeting guide wire in left subclavian puncture during percutaneous implantation of port-catheter systems using the catheter tip fixation method.

Our objective was to evaluate the feasibility and safety of a new method in approaching the access route percutaneously for the implantable port-catheter system for repeated hepatic arterial infusion chemotherapy. Fifteen patients underwent port-catheter system placement via the left subclavian artery with the catheter tip fixed within the gastroduodenal artery with embolic materials and a catheter side hole opening to the common hepatic artery. Before port-catheter placement, the right gastric artery was embolized via the femoral catheter access. Then a 0.035-in. guide wire was inserted from the right femoral artery to the left subclavian artery. The guide wire was left in place during puncture by the needle as an access route for catheter placement. At the time of puncture, the tip of the puncture needle was aimed at the guide wire placed in the subclavian artery beforehand. In all 15 patients the procedure was successfully completed in a reasonable time (mean time 95.0 min, range 50-240 min). Complications occurred in two patients: a transient numbness of the arm in 1 patient and a mild hematoma detected in the subcutaneous pocket in another patient. This experience indicates the possibility of using a targeting guide wire in puncture of the subclavian artery as an access route for catheter placement.

Catheterization, Peripheral↗
PubMed1990

Glove punctures in an orthopaedic trauma unit.

A series of 421 operations in an orthopaedic trauma unit have been studied for glove punctures; 37.5 per cent of operations had a puncture demonstrated in the surgeon's gloves. The procedures at a high risk of glove punctures were hip operations (57 per cent) and internal fixation (54 per cent). The use of double gloving reduced the contamination of the surgeon's hand in these operation groups to 17 per cent (P less than 0.05). The potential risk of the surgeon being infected by his patients has become increasingly important with the increase in the number of people infected with HIV. The trauma surgeon is at a high risk due to frequent spillage of body fluids in trauma and the difficulty in identifying patients who may be at risk. Reducing the risk to the surgeon is difficult but awareness of the areas of potential contamination such as glove puncture may help.

Cross Infection↗
PubMed1986

Induction of spermidine/spermine N1-acetyltransferase in needle-punctured rat lens as a model of traumatic cataract.

Isolated rat lens was punctured with a needle at a single point in the equatorial region and was incubated at 37 degrees C. Spermidine/spermine N1-acetyltransferase activity was increased about 5-fold at 8 h after the puncture. Concomitantly, putrescine content in the lens increased markedly at 8-16 h after the puncture, while spermidine levels were slightly depressed. Pretreatment of the lens with actinomycin D or cycloheximide blocked the increases of spermidine/spermine N1-acetyltransferase activity and putrescine content. Ornithine decarboxylase, on the other hand, was not induced to a detectable degree by this stimulus and 5 mM difluoromethylornithine could not block the increase of putrescine content. Polyamine oxidase showed a relatively constant activity that was sufficient for the metabolism of newly formed N1-acetylspermidine. These results suggested that, in the punctured lens, the polyamine levels were regulated predominantly by the activity of spermidine/spermine N1-acetyltransferase, but not by the induction of ornithine decarboxylase.

Acetyltransferases↗
PubMedDate not supplied

Puncture wounds to the foot.

Puncture wounds to the foot are common presenting problems in most busy emergency departments. Although seemingly benign, the sequelae after simple puncture wounds to the foot can include cellulitis, retained foreign bodies, or even osteomyelitis. Inadequate scientific research on this topic has left only anecdotal or retrospective reports for review in the medical literature. Antibiotics, radiographs, or surgical exploration in the management of puncture wounds to the foot all lack clinical studies to support their use. This review summarizes the literature and points to the inconsistencies in the management of puncture wounds to the foot.

Cellulitis↗
PubMedDate not supplied

Acupuncture for the treatment of cocaine addiction. Investigation of a needle puncture control.

We conducted a 6-week, single-blind study of acupuncture for cocaine dependence in methadone-maintained patients (N = 40) for the purpose of identifying an appropriate needle puncture control for use in future large-scale clinical trials. Patients were randomly assigned to receive daily acupuncture in three auricular sites plus one body site (LI-4), or in control sites within 2-3 mm of the four active sites. Overall, there was a positive response to treatment on a variety of drug-related and psychosocial measures. Cocaine use decreased significantly for patients in both needle puncture groups. The only statistically significant difference between the two types of needle puncture was on ratings of craving. Subjects rated each type of needle puncture as equally credible and perceived no significant differences on the acute effects of the two types of needle insertions. Power calculations based on these findings suggest that very large sample sizes would be required to detect treatment differences between this control condition and active acupuncture. Alternative controls are suggested, and the challenges inherent in implementing controlled clinical trials of acupuncture are discussed.

Acupuncture Points↗
PubMedDate not supplied

Headache prevention following accidental dural puncture in obstetric patients.

STUDY OBJECTIVE: To evaluate the efficacy of a prophylactic saline patch and a prophylactic blood patch in prevention of headache following accidental dural puncture in obstetric patients. DESIGN: Prospective, randomized, single-blind study on dural puncture headache occurrence and cessation. SETTING: Inpatient obstetric unit at a metropolitan medical center. PATIENTS: Seventy-four inpatients who underwent vaginal delivery or cesarean section following accidental dural puncture during administration of epidural anesthesia for labor and delivery. INTERVENTIONS: Group 1 (n = 24), the control group, received fluids and analgesics. Group 2 (n = 30) received prophylactic epidural saline (40 to 60 ml) through the epidural catheter following completion of the obstetric procedure. Group 3 (n = 20) received autologous blood (15 ml) via epidural catheter following completion of the obstetric procedure. MEASUREMENTS AND MAIN RESULTS: In Group 1, 21 of 24 patients (87.5%) developed headaches, with conservative management. In Group 2, 20 of 30 patients (66.7%) developed headaches, and in Group 3, 1 of 20 patients (5%) developed a headache. CONCLUSIONS: The results of this study suggest that the administration of a prophylactic epidural blood patch is highly effective in the prevention of headaches following dural puncture, with headache frequency reduced from 87.5% to 5%.

Analgesics↗
PubMed1990

Successful treatment of recurrent corneal erosion with Nd:YAG anterior stromal puncture.

I used a new technique to create anterior corneal stromal punctures for the treatment of traumatic recurrent corneal erosions that had not responded to conventional therapy. Three patients with such erosions within the visual axis were successfully treated by using multiple applications of the Nd: YAG laser set at energy levels between 1.8 and 2.2 mJ. One of these patients had previous stromal puncture with a bent 25-gauge needle. The erosions of all patients healed without complications and have remained symptom-free for four to six months. Compared with needle puncture, the laser punctures were more reproducible, shallow, and translucent.

Adult↗
PubMed2006

[Foam echosclerotherapy by puncture-direct injection: technique and quantities].

Foam echosclerotherapy by puncture - direct injection (EMPID) is a technique approved by the French Health Authorities for the management of varicose veins. It combines two principles: the injection of a sclerosing agent by echomonitored direct puncture and the use of this sclerosing agent as a foam. The procedure consists of four stages: targeting of the vein to sclerose and selection of the puncture site, venous puncture under echographic guiding, injection of the sclerosing product under complete echographic monitoring, and post-injection control, checking for the impact of the action and the distribution of the foam in the treated vein. First intention indications concern essentially isolated troncular reflux in lesser and great saphena veins and varicose recurrences. In second intention, EMPID is also an alternative to conventional varicose resection surgery. Emphasizing the principle of precaution, we underline the usefulness of a fine, extemporaneous, standardized and reproducible microfoam - high doses, in particular large volumes of foam, are unwarranted since it has been proven that small volumes are as effective. The recommended concentrations are directly linked to the maximal diameter of the saphena trunks targeted. The volume of foam to be injected must be determined on an individual basis and depends on the presence or not of post-injection spasm, the degree of venous filling and the endothelial impregnation of the treated varicosity (which can be easily monitored because of the spontaneous visualization of the foam producing a tracing effect on the ultrasound); it should not exceed 7.5 ml per session. Apart from the classical side effects due to the liquid form, the foam presents its own, very rare, side effects consisting of minor, constantly and spontaneously reversible, eye disorders. The foam is contraindicated for patients suffering from migraine due to higher incidence of such visual disorders. EMPID is an outpatient procedure for the treatment of varicosities which requires considerable operator skill. This technique cannot be proposed on a large scale without proper and specific training.

Eye Diseases↗
PubMedDate not supplied

US-guided puncture of the internal jugular vein: complications and anatomic considerations.

PURPOSE: To examine success and complication rates for ultrasound (US)-guided cannulation of the internal jugular vein (IJV) in comparison with blind techniques and to present the variations in anatomy of the IJV. MATERIALS AND METHODS: Data were prospectively collected for 869 cases of sonographically guided cannulation of the IJV. In all cases, the side of the puncture, procedural success or failure, and any immediate complications were recorded. In 764 (88%) cases, the number of passes required and whether a single- or double-wall puncture was used were recorded. In 690 (79%) cases, IJV diameter and depth were recorded, while its relationship to the common carotid artery (CCA) was noted in 659 (76%) cases. RESULTS: Cannulation was successful in 868 (99.9%) cases. Complications occurred in 20 (2.3%) cases. Eighty-seven percent of cannulations were achieved with one pass and 83% with a single-wall puncture. Success at first pass was significantly correlated with right-sided puncture and the diameter of the IJV. In 5.5% of cases, the IJV lay medial to the CCA, making successful cannulation with use of the landmark technique unlikely. CONCLUSIONS: US-guided cannulation of the IJV is superior to blind techniques, increasing the success rate and incidence of first pass cannulation and reducing the incidence of complications.

Adolescent↗
PubMedDate not supplied

Lack of efficacy of an epidural blood patch in treating abducens nerve palsy after an unintentional dura puncture.

BACKGROUND AND OBJECTIVES: Unintentional dural puncture with a Tuohy epidural needle during the course of an epidural anesthetic may lead to a postdural puncture headache and double vision. We describe a parturient that developed left abducens nerve palsy after an epidural anesthetic for labor. METHODS: A 32-year-old female developed a postdural puncture headache 1 day after an epidural anesthetic for labor. Over the next several days she began to complain of diplopia. Subsequent to this, she developed lateral rectus muscle palsy. RESULTS: The lateral rectus palsy resolved spontaneously 8 weeks after the epidural anesthetic. CONCLUSIONS: We believe that a dural puncture during an attempted epidural anesthetic resulted in cerebrospinal fluid (CSF) leakage with a consequent headache. The CSF leak caused traction on the sixth cranial nerve resulting in lateral rectus muscle palsy. An epidural blood patch performed after the onset of symptoms did not acutely resolve the abducens nerve palsy.

Abducens Nerve Diseases↗
PubMed2004

Thoracic epidural puncture guided by an acoustic signal: clinical results.

BACKGROUND AND OBJECTIVE: In previous studies we have demonstrated that it is possible and safe to identify the lumbar epidural space by an acoustic and visible signal. The use of an experimental set-up constructed for this purpose, the acoustic puncture assist device, the lumbar epidural puncture procedure became both audible and visible. In the present study we have extended the use of the device to localize the thoracic epidural space. We have also evaluated whether the device can be used as a practical tool to confirm correct catheter placement. METHODS: In 100 consecutive patients a prototype of the acoustic puncture assist device was connected to the epidural needle in order to localize the epidural space. The device translates the pressure encountered by the needle tip into a corresponding acoustic and visible signal and enables the anaesthesiologist to detect the epidural space by means of the acoustic signal. After catheter insertion, local anaesthetic was administered. Subsequently the epidural block was tested. In 10 patients the device was also connected to the epidural catheter after its insertion into the epidural space. RESULTS: In all 100 patients included in the study the epidural space was successfully located by means of the acoustic signal. The only recorded complication was intravascular catheter placement in two patients. CONCLUSIONS: It is possible to localize the thoracic epidural space guided by an acoustic signal. The method was shown to be safe, reliable and simple. Potential implications of this technique include better needle control, improved monitoring for training purposes and for clinical documentation of the thoracic epidural puncture as well as identifying correct catheter placement.

Acoustics↗
PubMed2003

Decrease in the incidence of post-dural puncture headache: maintaining CSF volume.

The incidence of epidural needle-induced post-dural puncture headache (PDPH) in parturients following dural puncture with a large bore (18-gauge) needle has been reported to range 76-85%. We describe seven cases in which the performance of epidural anesthesia in parturients was complicated by an unintentional dural puncture with an 18-gauge epidural needle. In all seven cases, the unintentional dural puncture was followed by (i) injection of the CSF in the glass syringe back into the subarachnoid space through the epidural needle, (ii) insertion of a epidural catheter into the subarachnoid space (now referred to as an intrathecal catheter), (iii) injection of a small amount of preservative free saline (3-5 ml) into the subarachnoid space through the intrathecal catheter, (iv) administration of bolus and then continuous intrathecal labor analgesia through the intrathecal catheter and then (v) leaving the intrathecal catheter in-situ for a total of 12-20 h. PDPH occurred in only one of these cases (14%).

Adult↗
PubMed2001

An audit of epidural blood patch after accidental dural puncture with a Tuohy needle in obstetric patients.

We report the results of a prospective audit of accidental dural puncture in 100 obstetric patients in a single tertiary referral institution during the period 1993 to 1999. The post dural puncture headache rate was 81%. Of the 81 parturients with post dural puncture headache, 58 (72%) received a therapeutic epidural blood patch, using 7 to 25 mL of autologous blood. After the initial blood patch, complete relief of headache was obtained in 67% and complete or partial relief in 95%. However, severe headache returned in 31% and 28% received more than one blood patch. The incidence of complete relief of headache with one blood patch or more was 50%, with 38% achieving partial relief and 12% having unrelieved headache. There was no significant association between volume of blood used for blood patch and success rate. The initial rate of resolution of headache did not differ significantly between parturients receiving a blood patch within 48 h of dural puncture and after 48 h (P =0.70). However, in the former group, the incidence of recurrent headache was significantly higher (59% versus 11%, P<0.001).

Journal Article↗
PubMed2002

Spontaneous intracranial hypotension--lessons to be learned for the investigation of post dural puncture headache.

We describe a case of spontaneous intracranial hypotension in a 36-year-old woman. This condition shares many of the features of post dural puncture headache, but without a dural puncture having been performed. The aetiology and management of this rare condition are discussed. We believe from experience within our own unit that most anaesthetists are unaware of spontaneous intracranial hypotension. Highlighting this condition is important, as anaesthetists are often involved in its management. In our case, radiological investigation involved the use of spiral computerised tomography to identify the site of the hole in the dura. Spiral computerised tomography is a relatively recent innovation, which may also be useful in the investigation of post dural puncture headache when the level of the puncture is unknown.

Journal Article↗
PubMed2000

[Initial experiences with a new optical target system (SimpliCT) for CT-guided punctures].

PURPOSE: To evaluate the prototype of a new optical target device for CT-guided punctures and interventions. METHODS: An optical target device for CT-guided punctures was applied in 24 interventions. The system consists of a laser target device mounted on a stand. The biopsy needle is adjusted according the course of a laser beam. The target angle has to be adjusted on the laser unit. The laser carrier can be moved along an 90 degrees-angled rail, allowing punctures from any angle in plane. Furthermore, angulation in the z-plane is possible, supporting interventions with gantry tilt. Size and depth of the target lesions, the planned and the actual angle of the inserted needle, the numbers of corrections of the needle position, and the time required for the puncture were evaluated. The user rated the benefit of the system and the ease of the application. RESULTS: All 24 interventions were carried out successfully. The mean difference between the planned and the actual angle of the needle was 1.3 degrees (SD: 0.7 degree). The system was considered as easy to handle and as a valuable aid. CONCLUSIONS: The laser target device is a simple navigation system which allows accurate positioning of a needle. Requiring an acceptable low preparation time, it easily can be integrated into the procedure.

Adult↗
PubMed1997

[Fine needle capillary cytology versus fine needle aspiration cytology--a comparison of quality between puncture techniques in the ENT area].

BACKGROUND: Needle aspiration is currently a widely used technique in the diagnosis of unclear lesions in the head and neck region. We present a modified technique of fine needle biopsy in ENT, "fine needle capillary technique". The basics of this technique were developed by Zajdela and coworkers (1987) as a cytological method of fine needle biopsy in benign and malignant mammary tumors. Fine needle capillary technique does not require aspiration of cell samples via negative pressure created by a syringe. A thin 25 G needle (outer diameter 0.50 mm, length 25 mm) is introduced into the lesion with one hand. The cells are detached by the cutting edge of the needle and are conducted into the lumen by capillary force. The needle is removed and the cellular material is expelled onto a glass slide, spread, and immediately fixed. METHOD: In a series of 166 patients with unclear lesions in the head and neck region, we compared the fine needle capillary technique with the classic fine needle aspiration technique in each patient. Regarding quality and assessment of the cytological smear the fine needle capillary technique proved clearly superior in most of the cases. Lymph nodes, tumors of the salivary glands, thyroid glands, branchiogenic cysts, one atheroma, one lipoma, and one skin metastasis of a squamous cell carcinoma were punctured. RESULTS: In our study fine needle capillary technique showed a very good quality of the cytological smear in 24.7% of all cases, while fine needle aspiration technique reached 12.1% only. A good quality was obtained in 51.2% with fine needle capillary technique and in 51.8% with fine needle aspiration technique, poor quality in 24.1% with fine needle capillary technique and in 36.1% with fine needle aspiration technique. Nondiagnostic cytology was obtained in 21.7% with fine needle capillary technique and in 32.5% with fine needle aspiration technique. Both techniques together showed insufficient material in 10.8%. The quality of the cytological smear in each region was always better with fine needle capillary techniques than with fine needle aspiration technique except five punctures of the submandibular gland. Of 166 patients 113 (68.1%) underwent surgery, and a correlation of the cytologic report to the surgical specimen showed agreement in 95.7% with fine needle capillary technique and in 90.5% with fine needle aspiration technique. In 17.7% with fine needle capillary technique and in 25.7% with fine needle aspiration technique it was not possible to compare the cytological smear with the histological results because of poor quality of the cytological smear. In four cases (4.3%) with fine needle capillary technique the cytological diagnosis was wrong. With fine needle aspiration technique, a wrong diagnosis occurred eight cases (9.5%). CONCLUSIONS: Fine needle capillary technique offers several advantages. Without aspiration trauma to cells and tissues is reduced. Less blood in the samples results in higher quality of the cytological smear. These circumstances make it easier for the pathologist to comment the cytological findings. The handling of the needle is practiced with a wrist movement and not from the shoulder joint as in aspiration method using the Cameco syringe holder. This allows for a more sensitive puncture technique touching the lesion during sampling with the finger tips. The puncture causes less pain than the aspiration technique. Our results demonstrate that fine needle capillary technique is the better method of fine needle biopsy in the head and neck region.

Biopsy, Needle↗
PubMed1980

Intracellular voltage of isolated epithelia of frog skin: apical and basolateral cell punctures.

Isolated epithelia of frog skin were prepared with collagenase, and the cells were punctured with intracellular microelectrodes across their apical (outer) and basolateral (inner) surfaces. Regardless of the route of cell puncture, the intracellular voltage (Vosc) in short-circuited isolated epithelia was markedly negative, averaging -70.4 mV for apical punctures and -91.6 mV for basolateral punctures. As in intact epithelia, amiloride outside caused the Vosc to become more negative (means of -96.7 and -101.8 mV), with a concomitant increase in the resistance of the apical barrier. Increasing the [K)i of the basolateral solution from 2.4 to 8.0 or 14.4 mM caused rapid step depolarization (5-10 s) of the Vosc under transepithelial Na transporting and amiloride-inhibited conditions of Na transport, with the delta Vosc ranging between 23.9 and 68.3 mV per decade change of [K]i. The finding that the Vosc of isolated epithelia of frog skin is independent of the route of cell penetration is consistent with the notion that the cells of the stratified epithelium are electrically coupled (functional syncitium). Moreover, the isolated epithelium can serve as a useful preparation, especially in studies designed to investigate the properties of the basolateral surfaces of cells.

Animals↗