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At least 649 records · Page 36Linked to original sources
PubMed1997

The value of lumbar puncture in the evaluation of critically ill, non-immunosuppressed, surgical patients: a retrospective analysis of 70 cases.

OBJECTIVE: To evaluate the diagnostic value of lumbar puncture (LP) in surgical intensive care unit (SICU) patients. DESIGN: Retrospective chart review. SETTING: Surgical intensive care unit at a major tertiary care medical center. PATIENTS: All patients admitted to the SICU during the period 1987-1995 who had a lumbar puncture, excluding those with a history of recent head trauma or a neurosurgical procedure. MEASUREMENTS: Cerebral spinal fluid (CSF) results, indication for lumbar puncture; admitting service, length of ICU stay, presence of fever and use of antibiotics. RESULTS: Of 7,555 admissions to the SICU over the period 1987-1995, 204 patients underwent LP during the hospital admission. Four charts could not be located and 75 patients underwent LP in locations other than the SICU. Of the remaining 125 cases, 55 carried a neurosurgical diagnosis and 70 had non-neurosurgical problems. Fifty-three (75%) of the patients had received antibiotics prior to the procedure. Among the 70 cases without a primary neurosurgical diagnosis, LP was performed to rule out infective meningitis suggested by fever and mental status changes (30 patients), mental status changes alone (7 patients), systemic illness with fever and/or mental status changes (10 patients), seizures (10 patients), meningismus (+/- fever, 4 patients), or a combination of neurological findings (8 patients). There were no cases in which meningitis was positively diagnosed. Medical management was altered in only two patients based upon the results obtained by LP. CONCLUSIONS: We conclude that LP in SICU patients without a recent history of head trauma or a neurosurgical operation is a low yield procedure, especially for the diagnosis of bacterial meningitis.

Adolescent↗
PubMed2000

Iatrogenic vertebral body compression fracture in a premature infant caused by extreme flexion during positioning for a lumbar puncture.

We present a case of vertebral body compression fracture that resulted from manual flexion of the spine of a premature infant in preparation for a lumbar puncture. Vertebral body fractures due to abnormal flexion in child abuse have been described. However, such fractures due to lumbar puncture-related positioning have not been reported. We present a pre-term infant who developed an L3 vertebral body compression fracture immediately after lumbar puncture.

Female↗
PubMedDate not supplied

Prospective nonrandomized trial of manual compression and Angio-Seal and Starclose arterial closure devices in common femoral punctures.

We compared the use of manual compression and Angio-Seal and Starclose arterial closure devices to achieve hemostasis following common femoral artery (CFA) punctures in order to evaluate safety and efficacy. A prospective nonrandomized, single-center study was carried out on all patients undergoing CFA punctures over 1 year. Hemostasis was achieved using manual compression in 108 cases, Angio-Seal in 167 cases, and Starclose in 151 cases. Device-failure rates were low and not significantly different in the two groups (manual compression and closure devices; p = 0.8). There were significantly more Starclose (11.9%) patients compared to Angio-Seal (2.4%), with successful initial deployment subsequently requiring additional manual compression to achieve hemostasis (p < 0.0001). A significant number of very thin patients failed to achieve hemostasis (p = 0.014). Major complications were seen in 2.9% of Angio-Seal, 1.9% of Starclose, and 3.7% of manual compression patients, with no significant difference demonstrated; 4.7% of the major complications were seen in female patients compared to 1.3% in males (p = 0.0415). All three methods showed comparable safety and efficacy. Very thin patients are more likely to have failed hemostasis with the Starclose device, although this did not translate into an increased complication rate. There is a significant increased risk of major puncture-site complications in women with peripheral vascular disease.

Arterial Occlusive Diseases↗
PubMedDate not supplied

CTF-guided puncture of an unenhanced isodense liver lesion during continuous intravenous injection of contrast medium.

CT fluoroscopy (CTF) facilitates guidance of percutaneous biopsies and other interventional procedures. We wished to demonstrate the usefulness of CTF for the puncture of an unenhanced isodense liver lesion during continuous injection of intravenous contrast medium. We performed CTF-guided puncture of a 2-cm lesion in the liver of a patient suffering from lung cancer. CTF enables puncture of liver foci even if they are unenhanced and isodense with the surrounding parenchyma.

Contrast Media↗
PubMed2006

Cerebrospinal fluid dissecting into spinal epidural space after lumbar puncture causing cauda equina syndrome: review of literature and illustrative case.

OBJECTS: We report a case of epidural cerebrospinal fluid (CSF) leak after lumbar puncture caused by CSF dissecting into the spinal epidural space. The incidence of this phenomenon may be higher than suspected, although most cases may remain asymptomatic. MATERIALS AND METHODS: A 4-year-old girl with new-onset seizure underwent a diagnostic lumbar puncture, the results of which were normal; 3 h later, she began experiencing severe low-pressure headaches and lower back pain, bilateral lower extremity weakness, numbness, and pain, and urinary retention when upright. Spinal MRI demonstrated extensive epidural CSF collection posterior to the thecal sac extending from the cervicothoracic junction to the sacrum. After 48 h in the supine position and gradual mobilization, the patient had complete resolution of symptoms and no neurological sequelae. CONCLUSION: Patients usually recover without any neurological deficits after conservative treatment. Prone or lateral decubitus positioning immediately after lumbar puncture may decrease the incidence of this phenomenon.

Cerebrospinal Fluid↗
PubMed2006

The management of accidental dural puncture in pregnant women: what does an obstetrician need to know?

Post-dural puncture headache (PDPH) also known as spinal (or post-spinal) headache still remains a disabling complication of needle insertion into the subarachnoid space. Pregnant women are at particular risk of dural puncture, and the subsequent headache, because of sex, young age, and the widespread application of regional anesthesia. Accidental dural puncture complicating epidural anesthesia varies in incidence from 0.19 to 4.4%. The incidence of epidural needle-induced PDPH headache in pregnant women has been reported to range 76-85%. The classic symptoms of PDPH consist of photophobia, nausea, vomiting, neck stiffness, tinnitus, diplopia, and dizziness in addition to the often, severe cephalgia. This article reviews the current literature on the pathophysiology, incidence, prevention, and treatment of PDPH in pregnant women.

Anesthesia, Obstetrical↗
PubMed2001

Life-threatening intracranial hypotension after diagnostic lumbar puncture.

Intracranial hypotension syndrome as a complication of diagnostic lumbar puncture is a rarely observed entity. Intracranial hypotension syndrome is characterized by postural headache, neck pain/stiffness, blurred vision, nausea, vomiting, clouding of consciousness, dizziness and vertigo. The majority of cases resolve spontaneously with conservative treatment. Rarely, epidural blood patch is required. We report a 41-year-old man with multiple sclerosis, who developed intracranial hypotension syndrome after diagnostic lumbar puncture and who did not respond to conservative treatment. A subdural hematoma was subsequently found, when the patient showed considerable worsening of clinical conditions with life-threatening symptoms. Surgical evacuation of the subdural hematoma was not sufficient to improve significantly the patient's conditions, while complete symptoms remission was achieved 12 hours after epidural blood patch. We stress the need for epidural blood patch in any case of post-diagnostic lumbar puncture postural headache which does not resolve with conservative therapy.

Adult↗
PubMed1989

Factors influencing hemostasis after umbilical vein puncture in vitro.

Bleeding from the site of cordocentesis can be detected by ultrasound examination, but significant hemorrhage into the amniotic fluid rarely occurs. To evaluate the relative contribution of amniotic fluid thromboplastins and the quantity of Wharton's jelly in facilitating coagulation at the puncture site, amniotic fluid samples and umbilical cord segments were obtained at cesarean section from 20 patients. After puncture of the umbilical vein, bleeding times were measured in amniotic fluid and 0.9% sodium chloride. The quantity of Wharton's jelly was assessed by measuring umbilical cord circumference. Mean bleeding times were significantly shorter in amniotic fluid compared with saline solution, but there was no consistent relationship between bleeding times and umbilical cord circumference. We conclude that properties of amniotic fluid facilitate coagulation at the site of umbilical vein puncture.

Amniotic Fluid↗
PubMed1994

Enhanced stress responsivity of Tourette syndrome patients undergoing lumbar puncture.

Tourette's syndrome (TS) is a complex inherited neuropsychiatric disorder that is characterized by multiple motor and phonic tics. Stress-related fluctuations in symptom severity and medication responsiveness are common, and patients often report that tics are worsened by fatigue, emotional trauma, and anxiety. We examined the effects of lumbar puncture (LP) stress on plasma adrenocorticotropin (ACTH) and cortisol, urinary catecholamines, and self- and clinician ratings of anxiety in 13 medication-free TS patients and 10 normal controls, ages 17 to 41 years. The TS patients secreted significantly more ACTH than the normal controls in response to the stress of the lumbar puncture. Compared to the controls the TS patients had significantly greater postLP mean and postLP peak ACTH levels. The TS patients also excreted significantly more norepinephrine in the 20 hr preceding the lumbar puncture and reported higher levels of anxiety before and during the procedure than the controls. In addition, urinary norepinephrine excretion of the TS patients was significantly correlated with clinician ratings of tic severity. The results were not related to current levels of depression and anxiety. Taken together, these findings suggest that a subset of TS patients may be characterized by heightened reactivity of the hypothalamic-pituitary-adrenal axis and related noradrenergic sympathetic systems.

Adrenocorticotropic Hormone↗
PubMed1993

Manometry of esophageal varices: comparison of an endoscopic balloon technique with needle puncture.

BACKGROUND: A noninvasive technique of pressure measurement in esophageal varices using an endoscopic balloon has been shown to be reliable in vitro. In the present study, this method was tested in vivo. METHODS: Thirty-seven pressure measurements in esophageal varices were performed in 34 patients by two independent operators (A and B) using an endoscopic balloon and compared with measurements performed by needle puncture by a third operator (C). RESULTS: Three measurements performed with the endoscopic balloon were rejected because they were noninterpretable. Measurements performed by A and B correlated well (correlation coefficient, 0.90); interobserver variability (r) was 0.88. Of 37 punctures performed for pressure measurements, 4 resulted in bleeding and 8 measurements were rejected as uninterpretable. Regression analysis showed a good correlation between the needle puncture and balloon techniques for pressure measurements performed by both operators (y = 5.3 + 1.0x, r = 0.8; y = 6.2 + 0.9x, r = 0.8), and analysis of variability showed a measurement bias of -5.3 +/- 4.1 and -4.1 +/- 3.5 cm H2O. No significant difference in variceal size measured with the endoscopic balloon or endoscopic forceps was found. CONCLUSIONS: The endoscopic balloon allows measurement of pressure in esophageal varices without hazard to the patient; in addition, it may be used to assess the varix size.

Adult↗
PubMed1990

Post-lumbar puncture headache: the relation between experimental suprathreshold pain sensitivity and a quasi-experimental clinical pain syndrome.

The relation between general experimental pain sensitivity and the clinical expression of post-lumbar puncture syndrome (PLPS) was examined in a prospective double-blind study of patients who underwent a lumbar puncture with a 20-gauge spinal needle. In 44 neurology patients randomized pain was induced on the middle phalanges of fingers II-IV of both hands using a tension device on the day before lumbar puncture. Pain intensity was measured using the category sub-dividing procedure. The correspondence between experimental pain stimuli and induced pain intensities could best be described by a logarithmic function. PLPS symptoms were documented in a multi-dimensional quantitative fashion using various scales. Pronounced position-dependent headache occurred in 31% of the patients. There proved to be very significant effects of experimental pain sensitivity on intensity and duration of position-dependent headaches, as well as on vegetative symptoms of PLPS (P less than or equal to 0.01). The results provide an explanation for the varying interindividual manifestation of PLPS symptoms, in addition to factors already identified such as the size of needle used in individual patients.

Adult↗
PubMedDate not supplied

A simple treatment of post-lumbar-puncture headache.

We report a case of post-lumbar-puncture headache successfully treated with intravenous caffeine sodium benzoate. The patient presented to the emergency department with a severe headache three days after a myelogram of the lumbar region. Caffeine sodium benzoate (500 mg) in 1 liter of fluid (D5LR) intravenously over one and a half hours was administered. The patient reported complete resolution of symptoms and no recurrence of headache. Caffeine sodium benzoate is a simple treatment of post-lumbar-puncture headaches. It should be considered as a safe alternative to an epidural blood patch for the treatment of post-lumbar-puncture headaches.

Adult↗
PubMed1995

Parturient's posture during epidural puncture affects the distance from skin to epidural space.

STUDY OBJECTIVE: To assess the factors affecting the distance from skin to epidural space. DESIGN: Prospective observational study of consecutive cases over a 2-year period. SETTING: Inpatient obstetric unit in a French university hospital. PATIENTS: 2,123 consecutive term parturients who received epidural anesthesia for cesarean section or epidural analgesia for labor and vaginal delivery. INTERVENTIONS: At the time of epidural puncture, the interspace used and the patient's posture (sitting or left lateral decubitus) were recorded, and the distance from the skin to the epidural space (DS-ES) was measured to the nearest 0.5 cm using a marked epidural needle. MEASUREMENTS AND MAIN RESULTS: The relationship between patient factors [height, weight, body mass index (BMI; weight/height2), presence of scoliosis] and technical factors (interspace, patient's posture at puncture) versus DS-ES was investigated using multiple regression analysis. DS-ES correlated positively with the parturient's weight and BMI. In addition, DS-ES was significantly greater when epidural puncture was performed in the lateral position as compared with the sitting position. CONCLUSION: Both the patient's weight and position during epidural needle placement are important factors influencing DS-ES. A change from the sitting to the lateral position may increase DS-ES, causing catheter dislodgment and consequent inadequate analgesia. Clinical studies relating DS-ES to inadequate analgesia must take these factors into account.

Adult↗
PubMed2004

Acute subdural haematoma after accidental dural puncture during epidural anaesthesia.

A case is reported of acute intracranial subdural haematoma following accidental dural puncture during epidural anaesthesia. A 36-year-old primigravida with a gestation of 37 weeks and 3 days underwent caesarean section for which epidural anaesthesia was initially planned. An 18-gauge Tuohy needle was inserted into the L3-4 interspace but accidental dural puncture occurred. The needle was removed and general anaesthesia was initiated for surgery. On the second day post partum, the patient described a headache in both occipital area and neck that was relieved by lying down. On the seventh post-partum day she suffered tonic-clonic convulsions and underwent computerised tomography (CT). Despite different analgesic treatments and a normal CT, the patient suffered severe headaches in the following days. Magnetic resonance imaging revealed a 4-mm subdural hematoma in the right frontal area. The persisting headache decreased on day 12 and disappeared on day 14. The patient was discharged from hospital on day 15. The presence of post dural puncture headache complicated by atypical neurological deterioration following epidural anaesthesia should prompt the anaesthetist to consider the existence of intracranial complications and to seek immediate clinical and radiological diagnosis.

Adult↗
PubMed2005

Use of an information leaflet to improve general practitioners' knowledge of post dural puncture headache.

BACKGROUND: The number of women receiving neuraxial anaesthesia for labour and delivery is increasing. Women are also being discharged into the community sooner after delivery. Thus, complications arising from neuraxial anaesthesia may present to general practitioners, so it is of vital importance that they are familiar with and can manage potential problems associated with these anaesthetic techniques. METHODS: A questionnaire was sent to 126 local general practitioners to discover their knowledge of the symptoms, diagnosis and treatment of post dural puncture headache in the parturient. An information leaflet was then circulated to all general practitioners in the region, detailing headaches and other potential problems following epidural analgesia for childbirth, and the questionnaire was reissued. RESULTS: The first questionnaire demonstrated that they had poor knowledge of the symptoms, diagnosis and treatment of post dural puncture headache in the parturient. Following the dissemination of the information leaflet, responses to the second questionnaire showed a significant improvement. CONCLUSION: By comparing the two sets of answers, we demonstrated that the leaflet has successfully improved knowledge of post dural puncture headache and other potential sequelae of obstetric epidural analgesia among general practitioners.

Analgesia, Epidural↗
PubMed2005

Does postdural puncture headache left untreated lead to subdural hematoma? Case report and review of the literature.

The patient was a 39-year-old pregnant woman who was scheduled for cesarean section. Spinal anesthesia was induced using a 26-gauge needle with an atraumatic bevel. Postoperatively, the patient developed cranial subdural hematoma manifesting as severe non-postural headache, associated with right eye tearing, fifth cranial nerve palsy and left hemiparesis. The diagnosis was confirmed by computed tomography scan. The patient was managed by careful neurological follow-up associated with conservative treatment and recovered fully after 12 weeks. Our report reviews the literature on 46 patients who developed a postdural puncture headache complicated by subdural hematoma following spinal or epidural anesthesia. It is possible that postdural puncture headache left untreated may be complicated by the development of subdural hematoma. Patients developing a postdural puncture headache unrelieved by conservative measures, as well as the change from postural to non-postural, require careful follow-up for early diagnosis and management of possible subdural hematoma.

Adult↗
PubMed2006

Complications associated with the Angio-Seal arterial puncture closing device: intra-arterial deployment and occlusion by dissected plaque.

The Angio-Seal arterial closure device is widely used to prevent bleeding and facilitate early ambulation after arterial puncture. We had referred to us three female patients in whom this device had been used; its sponge had been unintentionally deployed in the arterial lumen. In a fourth female patient, a dissected plaque underneath the device occluded the femoral artery. Severe lower extremity ischemia occurred in each case. One intraluminal sponge was detected only after 20 days, when the patient had developed severe symptoms due to microembolization; in another patient, ischemia occurred 9 days after intraluminal deployment. In two, or possibly three, of the cases, the superficial femoral artery had been punctured. The device should not be used when the superficial femoral artery has been punctured, in which case complications are more likely to occur. Lower limb ischemia within several months after deployment of these devices should be investigated with duplex ultrasound scanning to examine the possibility that the ischemia may be caused by the device or by device-related thrombus. It is important to register the use of such devices in the procedural reports to make it possible to link their use to eventual later ischemic events.

Aged, 80 and over↗
PubMed2002

Glove punctures and postoperative skin flora of hands in cardiac surgery.

BACKGROUND: Surgical gloves are frequently perforated during operations, including heart operations. This infection risk factor is inadequately studied. METHODS: After preoperative hand disinfection and at the end of 116 heart operations, bacterial samples from hands of surgeons, altogether 800 samples, were taken. Glove punctures were examined with water test. RESULTS: Surgeons changed 70 gloves because of breakage during operations. Additionally, 154 of 400 (39%) gloves had holes in postoperative testing. The breakage rate of gloves increased from 30% in operations shorter than 3 hours to 65% when operations were longer than 5 hours. High bacterial counts of the hands were also more common after prolonged operations. CONCLUSIONS: Glove puncture rates and bacterial counts of hands increase with increasing operation time. We recommend changing of both gloves when a puncture is detected. Before donning new gloves, hands should be disinfected.

Aortic Valve↗