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PubMedDate not supplied

Epidural blood patch for post dural puncture headache: a handy ally [corrected].

BACKGROUND: Epidural blood patch is a well-known item in the management protocol of post dural puncture headache though never been practised or reported in our environment. The aim of this report is to document its efficacy and establish a rationale for its use. METHOD: A review of the case record of patients with post dural puncture headache and the relevant literature. RESULT: A case of post dural puncture headache was encountered at a free medical missionary outreach program following spinal anaesthesia for myomectomy. Having exhausted all the available conservative management options, she was offered epidural blood patch. The recovery profile was collected by assessment of her abilities and disabilities before and after the epidural blood patch, with visual analog scale for pain. The clinical condition improved a lot, with remarkable improvement in neck movement and the visual analog scale. CONCLUSION: We conclude that epidural blood patch is a superior therapy for post dural puncture headache and recommend that post-anaesthetic rounds be conducted routinely to identify complications and enable early institution of therapy.

Adult↗
PubMed1992

Surgical gloves--a comparative study of the incidence and site of punctures.

Five surgical teams in two operating suites were studied for three months with random allocation to receive either A or B operating gloves. The gloves were identified as used by the surgeon, the assistant and the scrub nurse. At the end of each day the gloves were tested by standard air insufflation and immersion under water. Surgeons experienced significantly more punctures 174:884 (19.7%) [17%-23%] than the scrub nurses or assistants 161:1770 (9.4%) [8.6%-10.2%]. Surgeons were particularly prone to experience punctures of the tip of the index or little finger of the left hand whereas nurses were more likely to experience punctures of the index finger and thumb of the left hand. There was a wide variation between the five surgical teams varying between 5.7% [2%-11%] and 37.5% [24%-52%] wearing B and 11.4% and 28.4% wearing A. There were significantly more punctures when wearing A gloves (23.0%) [20%-26%] than when wearing B gloves (15.8%) [13%-19%] for surgeons but no significant difference for surgical assistants or scrub nurses. Contrary to our expectation there were no significant differences between the two types in the tearing of cuffs (1% in each).

Equipment Failure↗
PubMed2004

[Effectiveness of epidural administration of saline solutions to prevent or treat postdural puncture headache].

Epidural anesthesia is the most versatile and widely used of the techniques for regional anesthesia. The most common complication of epidural or spinal anesthesia is postdural puncture headache. The loss of cerebrospinal fluid through the hole can be an important causative factor of this cephalalgia. Of the many methods recommended for preventing and treating postdural puncture headache, one is bolus administration or infusion of saline solution into the epidural space, by which both epidural and subarachnoid pressures are increased. We have reviewed the literature evaluating the effectiveness of this technique from 1967 to 2004, using the following search terms: anesthesia, spinal; anesthesia, epidural; analgesia, epidural; headache; postdural puncture treatment or prophylaxis; epidural injection; epidural saline. Few articles were found. The studies had small samples and most did not include a control group. The doses and methods of epidural administration of saline solutions were highly variable and the results were often contradictory. We conclude that using this technique to prevent and/or treat postdural puncture headache is difficult to justify.

Epidural Space↗
PubMed1989

[Optical assistance in guiding punctures under x-ray computed tomographic control].

The authors describe a new technic for realisation of CT-guided punctures. This original device uses a buna tourniquet placed on the table for drawing on the skin the site of puncture and a movable light-visor for guiding the needle during the puncture. The advantages of this device are: no using of disposable or sterilised material; total freedom of the hand during the puncture; to be simple and quick.

Biopsy, Needle↗
PubMed1987

[Comparison of vaginosonographic, transabdominal sonographic and laparoscopic follicle puncture for the retrieval of oocytes within the scope of an in vitro fertilization program].

For follicular aspiration and oocyte retrieval for in-vitro-fertilization (IVF) laparoscopy, laparotomy and different ultrasound guided methods like transvesical and transvaginal puncture can be used. Sonographically guided follicular aspiration has become more important because this procedure is less invasive. In this study we compared the results of 28 laparoscopical, 35 transabdominal and 21 transvaginal follicle puncture after successful cycle stimulation. Performing transvaginal puncture 4.7, using laparoscopy 3.4 and performing transvesical puncture 2.0 oocytes per attempt were retrieved. The advantages of transvaginal follicle aspiration were a shorter operation time, a superficial anesthesia and compared to laparoscopy a less invasive and simple technique. Therefore this method is now commonly used for routine IVF procedures in our institution.

Female↗
PubMed1988

[Optimizing puncture of the internal jugular vein. Effects and advantages of the Valsalva maneuver in catheterization].

Shortly after the publication by English et al. on catheterization of the internal jugular vein (VJI) in 1969, the first papers reporting complications appeared. To reduce the rate of puncture failures with their consequences and complications, we tried to find the optimal conditions for successful puncture by evaluating serial CT scans. The diameter increase of the VJI was studied in 8 women and 9 men with an average age of about 39 years with 30 mmHg pressure in the upper respiratory passages. The measurement was performed 2 cm below the level of the cricoid cartilage (the probable puncture point for posterior access). It was carried out first during normal respiration, then after forced inspiration and bearing down with the glottis open against a closed system consisting of a manometer. By means of continuous bearing down, a pressure of 30 mmHg was maintained during CT scanning. With this pressure in the upper respiratory passages, the mean increase in diameter of the VJI was 58% on the left side (P less than 0.002) and as much as 78% on the right (P less than 0.001), which is highly significant. In 12 of the 17 test persons (70.6%), the right VJI proved to be the dominant vessel, and the diameter increase achievable by the Valsalva maneuver likewise seems to be greater on the right side than on the left (Table 1). We now recommend a slight Trendelenburg position with the head rotated 45 degrees to the contralateral side. For the first puncture we consider the posterior approach (see Fig. 2) on the right side to be the best.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1985

[Application of computerized tomography to transthoracic puncture].

Transthoracic puncture for peripheral pulmonary lesions not diagnosed by fibroscopy were performed on 70 patients under computed tomographic (CT) control. Sixty four cases had a simple cytological puncture associated in 23 cases with a tru-cut biopsy. Six patients had a needle biopsy. The CT enabled us to localise the tumour to be punctured very accurately, whatever its size or topography in relation to the thoracic wall or mediastinum. It also distinguished necrotic zones within the body of the tumour whose biopsy would lead to false negative results. The sensibility for detecting malign tumours by this method was 83% for cytology and 90% when a biopsy was associated with cytology by needle aspirate. The specificity was 94%. A more precise histological diagnosis was correctly suggested by simple cytology in 7 patients (20%). A tru-cut biopsy enabled histological characterisation in all the neoplastic cases; amongst the benign lesions a specific diagnosis was made on the biopsy in 4 out of 10 cases. There were complications -9% overall. None of the pneumothoraces produced required surgical drainage. There were no fatal complications. In conclusion, transthoracic puncture under CT control is a sensitive method for detecting peripheral malignant tumours and is associated with a low level of complications.

Biopsy, Needle↗
PubMed1982

[Computer tomographic guided fine needle puncture of abdominal masses].

CT-guided fine-needle aspiration biopsy was carried out in 177 patients with proven intra-, retro- or extraperitoneal lesions. This method verified the diagnosis in 89/132 cases (66%) with malignant neoplasia, metastases and recurrent malignant tumors. In 45 patients with benign or inflammatory lesions of the intra- and retroperitoneal space, fine-needle puncture showed a purulent liquid, inflammatory altered cell elements or a positive bacteriological result. The success of CT fine-needle puncture depends mainly on the examiner's experience, the exact localization of the needle, and careful handling of the cytological material. Fine-needle puncture should be applied simultaneously with CT when an undefined space-occupying lesion is present. Unsuccessful sonography is an indication for CT-guided fine-needle puncture.

Abdominal Neoplasms↗
PubMedDate not supplied

[Ultrasonically guided puncture of nonpalpable breast cysts].

The technique and the success of ultrasonically guided punctures of nonpalpable breast cysts are presented. A total of 43 cysts were punctured. The average lesion diameter (means +/- SD) was 16.4 +/- 5.4 mm. The puncture was not successful in 20.9% of cases. The cell material obtained by puncture was adequate for analysis in 32 (74.4%) cases, in 11 (25.6%) cases the aspirates were not suitable for the setting of a diagnosis because of an insufficient number of cells or the absence of the cell material. Inflammation as a complication of the intervention was registered twice (4.6%).

Biopsy, Needle↗
PubMedDate not supplied

[Stability and immunogenicity of the fresh BCG vaccine applied with a new multiple puncture device (author's transl)].

A new multiple puncture instrument with interchangeable pieces has been devised. It permits the application of 12 or 28 cutaneous punctures, depending on the age of the patient (child). Fresh concentrated (50 mg/ml) BCG vaccine was distributed either into neutral glass ampoules or into neutral polypropylene tubes. No difference in viability was observed after storage at 4 degrees C and in a series of 10 batches of vaccine, a good survival (about 50%) was found after three months. Also, survival was identical among 9 batches of vaccine, whether it was resuspended in a protective solution containing human albumin plus 5% glycerol or in 6% glycerol only. The immunogenicity of the fresh concentrated vaccine, when applied with the new multiple puncture device, was studied using different tests: --the growth of BCG in organs of mice, --the survival time after virulent challenge of vaccinated versus unvaccinated mice, --tuberculin-delayed hypersensitivity of vaccinated guinea-pigs. The immunogenic potency has been found similar to that observed using other methods of BCG vaccination. These experimental results confirm the merit of the new method of vaccination using the multiple puncture device.

Animals↗
PubMed1980

Lymphocyte stimulation assay utilizing newborn heel skin puncture blood samples.

A micromethod for the study of lymphocyte stimulation using small volumes of blood obtained by heel skin or fingertip puncture is described. Heel skin puncture samples from 15 full term newborns and venous blood samples from 6 newborns gave very similar results. A study of paired venous blood and fingertip puncture samples from 5 normal adults and 2 children with severe combined immunodeficiency (SCID) showed no significant differences between lymphocyte responses of samples taken from these sites. The responses of adults were significantly lower than those of the full term newborns, while the responses of the SCID patients were markedly depressed. Lymphocyte stimulation studies using blood samples obtained by heel skin or finger puncture provide a useful method for detection of defects in cellular immunity in young infants.

Cells, Cultured↗
PubMedDate not supplied

[Headache following dural puncture in pregnant patients at term. Comparative study with non-obstetric patients].

OBJECTIVES: To compare the incidence of postdural puncture headache after subarachnoid anesthesia with a 24G Sprotte needle among full-term obstetric patients as compared to non-obstetric patients. PATIENTS AND METHODS: A total of 200 patients were studied prospectively, divided into 2 groups. Group 1 (n = 100) patients were delivered by cesarean section and group 2 (n = 100) patients underwent infraumbilical or traumatological surgery. All were ASA I-II and under 40 years of age. Hydration was accomplished with lactated Ringer's solution 400-1,000 ml before mid-line puncture. The anesthetic used in both groups was isobaric bupivacaine 0.5% with a vasoconstrictor. The incidence of arterial hypotension and accompanying symptoms was recorded; perioperative administration of vasoactive amines and anticholinergics and liquids administered was measured. Twenty-four to 48 hours later the patients were asked when they started walking and if postdural puncture headache was experienced. RESULTS: Group 1 received smaller doses of bupivacaine (p < 0.05) and the incidence of arterial hypotension was greater (p < 0.01) and required increased administration of amines (p < 0.01) and perioperative fluid therapy (p < 0.001). No difference was found between the two groups either for time of start of ambulation or for incidence of headache, which was 1% in both groups. CONCLUSIONS: The incidence of postdural puncture headache in obstetric patients is low and similar to that of non-obstetric patients when the 24G Sprotte needle is used.

Adolescent↗
PubMedDate not supplied

Bacterial pathogens in infected puncture wounds in adults with diabetes.

Infections resulting from puncture wounds to the foot in diabetics appear not to have been previously reported in the medical literature. The purpose of this report is to describe bacterial pathogens identified from bone and soft tissue infections precipitated by a puncture injury in patients with diabetes. In a 7-year retrospective study, the authors evaluated 22 patients with osteomyelitis and 44 patients with soft tissue infections. Medical records and operative culture and sensitivity reports were reviewed. Staphylococcus aureus (68%), Streptococcus species (44%), and Enterococcus species (27%) were the most common pathogens identified. Pseudomonas was more common in cases of osteomyelitis (36%) than in soft tissue infections (18%) (p < 0.001). Pseudomonas was more common in patients that had worn tennis shoes at the time of the puncture injury compared to patients that were barefoot or who wore some other type of footwear (p < 0.001). Seventy-four percent of patients had polymicrobial infections. Anaerobes were identified in only seven patients (11%). This study suggests that polymicrobial infections with few anaerobes are common in infected puncture wounds in diabetics. Pseudomonas is more common in bone infections and is associated with wearing tennis shoes at the time of injury.

Adult↗
PubMedDate not supplied

[The treatment of patients with chronic cerebral circulatory failure by using laser puncture and the microclimate of the biotron].

A mode is proposed of treatment of chronic cerebrovascular disorders, such as initial manifestations of cerebral blood supply insufficiency (IMBSI) and dyscirculatory encephalopathy (DE) stage I-II in hypertensive disease, involving the use of laser puncture and microclimate of biotron. All patients (n = 162) were exposed to laser puncture (10-12 procedures). Laser puncture treatments were devised according to classical approaches of reflexotherapy, using determinants of electropuncture diagnostic method by Riodoraku. The treatments were carried out with the aid of infrared portable laser "Biomed-001". IMBSI patients presenting with vegetovascular dystonia and about 70% of IMBSI patients presenting with hypertensive disease derived benefit from a course of laser puncture, as evidenced by REG, EEG, acupuncture diagnosis, iridodiagnosis according. In DE stage I-II patients and about 30% IMBSI patients presenting with hypertensive disease good therapeutic effect occurred after treatment in a ward with a stable microclimate of biotron. The proposed method can be used for treating chronic cerebrovascular disorders and administering stroke prophylaxis.

Acupuncture Points↗
PubMed2006

Post dural puncture headache in obstetric patients: experience from a West African teaching hospital.

BACKGROUND: This prospective, non-randomised study examined the frequency and severity of post dural puncture headache in 96 Ghanaian women who consented to spinal anaesthesia for caesarean section at the Korle Bu Teaching Hospital, Accra, Ghana. METHOD: Spinal anaesthesia was performed using 22-gauge (n = 22), 25-gauge (n = 46) or 26-gauge (n = 38) Quincke needles. Patients were followed up to determine the incidence and severity of post spinal headache. RESULT: The overall incidence of post dural puncture headache was 8.3%, but was significantly higher (33%) in patients in whom 22-gauge Quincke needles were used than in the other two groups (4% and 5% respectively: P = 0.003). Most patients rated their headache as mild to moderate on a 10-cm visual analogue scale. CONCLUSIONS: In view of the high incidence of headache and the need for treatment associated with the use of the 22-gauge Quincke needle, we recommend that this should not be used in the obstetric population. We are also aware that the incidence of post dural puncture headache could be further reduced by the use of small calibre pencil-point needles but these are currently very expensive and many obstetric units in developing countries may not be able to afford them.

Adult↗
PubMed1985

Neonatal ventricular haemorrhage: treatment by puncture.

Transfontanellar ventricular puncture and intermittent lumbar punctures were carried out in 10 patients affected by intraventricular haemorrhage during the period between 1980 and 1983. In only three of them was later a shunt necessary for treatment of hydrocephalus. Six children developed normally, in two severe mental retardation ensued, and two died later, one of heart failure after cardiac surgery and one of ventriculitis following shunt implantation. Puncture therapy can be recommended for intraventricular haemorrhage of the neonate.

Brain Damage, Chronic↗
PubMedDate not supplied

Visibility of puncture sites after external osteotomy in rhinoplastic surgery.

BACKGROUND: External lateral osteotomy performed through a small puncture incision in the skin has numerous advantages, but it has been criticized by its opponents who claim it may leave visible scars. OBJECTIVE: To examine whether the external lateral osteotomy actually leaves visible scars. METHODS: Eighty-one postoperative photographs of patients who had undergone the external lateral osteotomy technique were reviewed. The photographic slides were a mixture of some taken 3 months after surgery and others taken 6 months after surgery. Scar visibility was assessed. RESULTS: Percutaneous puncture site visibility as assessed by 3 surgeons independently was 0% at 6 months after surgery and about 3% at 3 months after surgery. CONCLUSION: The external osteotomy procedure produces an excellent cosmetic result at the puncture sites in the skin.

Cicatrix↗
PubMed2002

Lamina puncture: pars plana optic disc surgery for central retinal vein occlusion.

OBJECTIVE: To determine the feasibility of creating a perivascular space adjacent to the central retinal vein at the level of the lamina cribrosa as a potential method of reestablishing perfusion in central retinal vein occlusion. METHODS: Various designs for a puncture instrument, or lamina puncture lancet, were investigated in cadavers, pigs that had undergone enucleation, and in vivo rabbit eyes. RESULTS: A lancet with a sharp cutting edge on one side and an opposing blunt edge is repeatedly able to create a perivascular space with limited optic nerve fiber damage. CONCLUSIONS: Lamina puncture is technically feasible, and evaluation in carefully selected patients appears warranted.

Animals↗