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At least 667 records · Page 37Linked to original sources
PubMed1985

Biliary drainage by ultrasound-guided puncture of the left hepatic duct.

Percutaneous transhepatic biliary drainage under ultrasonic guidance was performed in 38 patients with obstructive jaundice due to malignancy (49 intubations). The method was used for palliation in 33 patients and for pre-operative drainage because of cholangitis in five patients. Puncture of the left lobar ducts was the method of choice (35 patients). Only in cases of poor visualisation of the left biliary ducts was right-sided drainage performed (three patients). Combined left- and right-sided drainage was necessary in nine patients. All attempts with ultrasound-guided punctures were successful. There were no complications related to the punctures. Delayed complications were cholangitis (10 patients) and bleeding (one patient). The advantages of the method compared with conventional percutaneous transhepatic biliary drainage and the advantages of the left liver lobe drainage are outlined.

Adenoma, Bile Duct↗
PubMed1998

Follicle aspiration with interactive three-dimensional digital imaging (Voluson): a step toward real-time puncturing under three-dimensional ultrasound control.

OBJECTIVE: To evaluate the possibility of performing puncturing procedures under three-dimensional ultrasound (US) control in close to real time using a new commercially available system and to describe the technique. DESIGN: Descriptive case study. SETTING: Private outpatient infertility clinic. PATIENT(S): A volunteer undergoing IVF-ET treatment. INTERVENTION(S): Transvaginal needle-guided aspiration of 10 follicles using a newly developed US machine with a built-in rapid and powerful calculation software program for three-dimensional interactive volume and flow translation during operation. Interactive three-dimensional imaging was carried out during the aspiration of each follicle. MAIN OUTCOME MEASURE(S): The delays caused by volume acquisition and the search for the needle tip with and without "power Doppler" were estimated and compared. RESULT(S): Oocyte recovery was successful from all follicles. There was a mean (+/-SD) delay of 5.00 +/- 1.22 seconds from coasting to resuming real-time US scanning during interactive volume calculation and the search for the needle tip in the three-dimensional mode. This did not delay the procedure remarkably but enabled the precise localization of both the needle and its tip after each penetration. The integration of flow signals allowed an impressive color-coded demonstration of the needle within the tissue, but the delay was significantly longer for color-coded volume acquisition (18.40 +/- 4.56 seconds). CONCLUSION(S): Recent technology enables the performance of three-dimensional puncture procedures in close to real time; this technology is demonstrated for follicle punctures but will be of more importance in fields such as fetal medicine, oncology, and surgery.

Computer Systems↗
PubMed1980

Posthemorrhagic hydrocephalus in low-birth-weight infants: treatment by serial lumbar punctures.

We have performed weekly computed tomographic brain scans on 28 surviving low-birth-weight infants with cerebral intraventricular hemorrhage and acute ventricular dilatation. Evolving hydrocephalus was observed in 15 infants. Twelve of the 15 infants were treated by removing large volumes of cerebrospinal fluid with serial lumbar punctures. Arrest in the progression of hydrocephalus was evident in 11 of the 12. Clinical hydrocephalus requiring surgical intervention occurred in one of the treated infants and in all three untreated infants. No complications of serial lumbar punctures were noted, whereas shunt-related morbidity was 100%. Our results suggest that serial lumbar punctures are effective in arresting the development of posthemorrhagic hydrocephalus.

Brain↗
PubMed1980

Failure of daily lumbar punctures to prevent the development of hydrocephalus following intraventricular hemorrhage.

A prospective study of 48 infants with periventricular-intraventricular hemorrhage was carried out to evaluate the role of daily lumbar punctures, instituted from the time of diagnosis of the hemorrhage, in prevention of posthemorrhagic hydrocephalus and improvement in immediate outcome. The data lead to the following conclusions: (1) minor hemorrhage (Grade I) is associated with minimal risk of death or hydrocephalus; (2) moderate hemorrhage (Grade II) is associated with low risk of death and intermediate risk of hydrocephalus, and serial lumbar punctures do not reduce these risks; and (3) severe hemorrhage (Grade III) is associated with high risks of death or hydrocephalus or both, and serial lumbar punctures also do not reduce these risks.

Brain↗
PubMed1994

Transurethral puncture of ectopic ureteroceles in neonates and infants.

Ten neonates and infants with 11 ectopic ureteroceles prospectively underwent transurethral puncture as the primary form of therapy. Of the 10 patients 6 had a prenatal diagnosis of uropathy and 4 presented postnatally with urinary tract infection. One patient had bilateral single system ectopic ureteroceles and 9 had a single ectopic ureterocele in a duplex system. Significant associated ipsilateral and/or contralateral urological pathology was noted in addition to the ectopic ureterocele in 7 patients. Transurethral puncture adequately decompressed 10 of the 11 ectopic ureteroceles (91%) and improved drainage of nonureterocele moieties in 3 cases. Iatrogenic reflux was found in 3 of the 11 ureterocele ureters. Urinary tract infection developed in 6 infants (4 with fever). Of the 10 patients 8 (80%) eventually required secondary surgical intervention because of recurrent urinary tract infections, persistent or iatrogenic reflux, or unresolving hydronephrosis. Although transurethral puncture rarely constitutes definitive treatment for ectopic ureterocele, there appears to be immediate benefit in cases of bilateral hydronephrosis or significant ipsilateral lower pole hydronephrosis. Decompression of the ureterocele is reliably obtained but it seldom obviates the need for more definitive reconstruction.

Female↗
PubMed1996

Patients with renal cysts associated with renal cell carcinoma and the clinical implications of cyst puncture: a study of 223 cases.

OBJECTIVES: To clarify the association between renal cysts and renal cell carcinoma (RCC), we analyzed patient demographics, types of cystic disease, and modes of cyst-tumor coexistence along with the results of cyst puncture. METHODS: A total of 507 hospitals provided information regarding clinical experiences with RCC and cyst puncture over a 2-year period. RESULTS: Renal cysts were identified by preoperative imaging in 223 (4%) of 5721 patients with RCC. Histologic examination revealed cystic RCC in 56 patients (25%) and RCC associated with cystic diseases in 167 (75%). Cystic disease included simple cysts in 72 patients (32%), acquired cystic disease of the kidney (ACDK) in 62 (28%), multilocular renal cysts in 20 (9%), polycystic kidney in 3 (1%), and unspecified or miscellaneous in 10. Cyst puncture performed in 47 (21%) of 223 patients demonstrated bloody fluid in 20 cases and nonbloody fluid in 27. Cytologic analysis of cystic fluid obtained from 37 patients revealed a malignancy in 5 (14%), accounting for 25% of the bloody and 4.8% of nonbloody specimens. Cytology failed to detect RCC in ACDK and multilocular cysts but was positive in cases of cystic RCC and solitary cysts. Four of 5 cytology-positive cases comprised those of tumor in cyst and cyst within tumor. CONCLUSIONS: Simple cysts and ACDK accounted for 60% of the renal cysts associated with RCC. Cystic RCC was involved in 25% of cases. Positive cytology may be expected in select cases, including those with close cyst-tumor relationships and those involving bloody cyst fluid. However, negative cytology does not exclude RCC.

Carcinoma, Renal Cell↗
PubMed2002

Development of a new vaccine delivery method for fish: percutaneous administration by immersion with application of a multiple puncture instrument.

A new administration method was developed for vaccination of juvenile rainbow trout against beta-haemolytic Streptococcus. This simple and convenient method was equal in effectiveness to intra-peritoneal injection. Small skin lesions were produced using a multiple puncture instrument while fish were immersed in a vaccine suspension containing formalin-killed Streptococcus iniae. Upon challenge 2 weeks after vaccination, mortality of fish vaccinated by this method was 40%, equal to that by intra-peritoneal injection, while non-vaccinated control fish and fish vaccinated by immersion (without multiple puncture) each experienced 80% mortality. High efficacy was obtained with the multiple puncture/immersion method even when vaccine was diluted 10-fold. Quantitative analysis using fluorescent microspheres revealed that both antigen uptake by skin and delivery to the kidney and spleen were more effective with this method than with immersion alone. Microspheres were found in the skin within the pinpoint lesions and pressure mark caused by multiple puncture instrument. The greater protection gained by the present method can be attributed to higher numbers of particulate antigens taken up by fish and delivered to the lymphoid tissues.

Administration, Cutaneous↗
PubMed2000

Cerebral herniation after lumbar puncture in sarcoid meningitis.

A patient with chronic meningitis due to neurosarcoidosis became comatose within minutes of a lumbar puncture and died 24 h later. The diagnosis of neurosarcoidosis was made post mortem. Development of cerebral herniation may have been exacerbated by lumbar puncture. It was proposed that arachnoid villi dysfunction may have contributed to very high intracranial pressures in this patient, since post mortem examination revealed communication between the ventricles and outlet foramina of the fourth ventricle, and that herniation was in part due to an acute pressure differential caused by lumbar puncture.

Adult↗
PubMed1998

Complications of lumbar puncture.

This article reviews historical aspects and the following complications of lumbar puncture: cerebral and spinal herniation, postdural puncture headache, cranial neuropathies, nerve root irritation, low back pain, stylet associated problems, infections, and bleeding complications. The incidence of postdural puncture headache can be greatly reduced by pointing the face of the bevel in the direction of the patient's side, replacing the stylet and rotating the needle 90;dg before withdrawing the needle, and using the Sprotte atraumatic needle, especially in high risk patients.

History, 19th Century↗
PubMedDate not supplied

Puncturing the pulseless femoral artery: a simple technique that uses palpation of anatomic landmarks.

PURPOSE: The authors report a simple technique in which palpation of anatomic landmarks is used to localize the pulseless common femoral artery. MATERIALS AND METHODS: A finger is placed immediately lateral to the pubic tubercle and inferior to the inguinal ligament to palpate the point allowing the most posterior depression. Anatomically, this depression lies between the iliopsoas muscle laterally and the pectineus muscle medially. The femoral vein lies in the floor of this depression, and 1.5 cm lateral to the depression lies the femoral artery. RESULTS: This anatomic relationship and its usefulness for locating the common femoral artery were verified by puncture and dissection of nine cadaveric groins and successful puncture of 19 pulseless arteries of 17 patients. CONCLUSION: The described technique was found to be quick, simple, and reliable and is now the authors' method of choice for puncturing the pulseless femoral artery.

Angiography↗
PubMed2006

Pneumorrhachis following lumbar puncture: a case report.

We report a rare case of pneumorrhachis following lumbar puncture. A 4-year-old boy was admitted to our hospital with seizures following a head injury and upper respiratory infection. Lumbar puncture was performed to rule out central nervous system infection. In response to leg pain and weakness a few hours after the procedure, lumbar spine computed tomography (CT) revealed pneumorrhachis at the level of L5-S1. In a follow-up CT scan 3 days later, the pneumorrhachis resolved spontaneously. Pneumorrhachis following diagnostic lumbar puncture is an extremely rare condition. We discuss pneumorrhachis and review cases in the literature.

Child, Preschool↗
PubMed1986

Impact of tracheoesophageal puncture prosthesis airway resistance on in-vivo phonatory performance.

Substantial differences have been established among in-vitro airway resistance properties of tracheoesophageal (TE) puncture prostheses (Weinberg & Moon, 1984). In this report, the impact of these in-vitro differences on the actual, in-vivo process of TE voice production is made explicit. Variation in in-vitro airway resistance among TE puncture prostheses is shown to exert substantial effects upon in-vivo phonatory mechanism opposition to flow, aerodynamic power required to initiate and sustain TE voice production, and TE phonatory efficiency. Individuals responsible for defining TE puncture options for laryngectomized patients are encouraged to consider these effects in clinical practice.

Airway Resistance↗
PubMed2003

Questioning the need for routine bone marrow aspiration and lumbar puncture in patients with retinoblastoma.

PURPOSE: This study assesses the value of routinely investigating children with retinoblastoma with bone marrow aspiration and lumbar puncture, staging investigations not without risk and trauma to the patient, emotional stress on parents and financial cost to the community. METHODS: Medical files and specimens were obtained and examined for patients with retinoblastoma presenting to the Royal Alexandra Hospital for Children, Camperdown and the Children's Hospital at Westmead, Sydney, from 1975 to 2001. RESULTS: In total, 123 patients presented; 62 (50.4%) were boys and 61 (49.6%) were girls. Of these 123 patients, 74 (60.2%) had unilateral disease, 46 (37.4%) involving the left eye and 28 (22.8%) involving the right eye. There were 47 (38.2%) patients with bilateral disease, and two (1.6%) with trilateral disease. Mean age of presentation was 17.9 months (23.1 months for unilateral subjects; 10.3 months for bi-lateral subjects; 3.5 months for trilateral subjects). There were 13 (10.6%) with a positive family history. Of 74 unilateral subjects, 70 (94.6%) required enucleation and four (5.4%) were salvaged. Of 47 bilateral subjects, 13 (27.7%) did not require enucleation, 27 (57.4%) required unilateral enucleation and seven (14.9%) required bilateral enucleation. Both trilateral subjects died. Of all 123 subjects, 112 (91.1%) had bone marrow aspiration and lumbar puncture performed during initial assessment, and none showed evidence of malignancy. CONCLUSIONS: Given the small but significant risks associated with these procedures, the results of this study cannot support bone marrow aspiration and lumbar puncture as routine investigations in all patients presenting with retinoblastoma, suggesting a more limited usage of these investigations is warranted.

Biopsy, Needle↗
PubMed1999

Postdural puncture headache is not an age-related symptom in children: a prospective, open-randomized, parallel group study comparing a22-gauge Quincke with a 22-gauge Whitacre needle.

Many reports have shown a low incidence of postdural puncture headache (PDPH) and other complaints in young children. The objective of this open-randomized, prospective, parallel group study was to compare the use of a cutting point spinal needle (22-G Quincke) with a pencil point spinal needle (22-G Whitacre) in children. We studied the puncture characteristics, success rate and incidence of postpuncture complaints in 57 children, aged 8 months to 15 years, following 98 lumbar punctures (LP). The patient/parents completed a diary at 3 and 7 days after LP. The response rate was 97%. The incidence of PDPH was similar, 15% in the Quincke group and 9% in the Whitacre group (P=0.42). The risk of developing a PDPH was not dependent on the age (r < 0.00, P=0.67). Eight of the 11 PDPHs developed in children younger than 10 years, the youngest being 23-months-old.

Adolescent↗
PubMed1993

The forgotten lumbar puncture.

Lumbar puncture is crucial in two distinct clinical situations in the diagnosis of the headache patient. The first is the patient who is suspected of having a symptomatic headache; the second is the patient with a chronic intractable or atypical headache disorder. This review discusses the usefulness of the lumbar puncture in the diagnosis of headache secondary to subarachnoid hemorrhage, meningitis, and intracranial hypotension and hypertension. The value of lumbar puncture in the presence of a normal CT/MRI scan is discussed.

Headache↗
PubMed1997

Post-lumbar puncture headache: clinical features and suggestions for diagnostic criteria.

The aim of the present prospective study was to describe clinical features of post-lumbar puncture headache (PPH), and to test the validity of the diagnostic criteria of the International Headache Society (IHS). Eighty-eight of the 239 included patients (36.8%) experienced PPH. Females were affected more frequently than males (45.2% vs 21.4%; p < 0.001). First onset of PPH occurred within the first day in 40 patients (53%), within 2 days in 89%, and never after the fourth day. When PPH occurred for the first time on the day the lumbar puncture was performed, it was usually experienced much later in the day (median 14.00 h) than it first occurred on the second day (median 09.30 h) or later. The median duration of PPH was 6 days (range 1-29 days). Patients with headache performed a "Rising Manoeuvre" twice daily as long as the headache period lasted, and recorded pain and time variables. The severity of PPH was negatively correlated to the time till the headache started or worsened upon rising (T1) and the time from the headache started to increase till it reached its maximum (T2), but was not significantly correlated to the time to restitution upon lying down (T3). The results are in good accordance with the leakage theory. T1 varied from immediate onset to 265 min (median 20 sec). T2 (median 30 sec, range 0-60 min) and T3 (median 20 sec, range 0-15 min) varied considerably as well. During the course of PPH, 45% of the patients occasionally reported non-postural headache or no headache when the Rising Manoeuvre was performed. It is suggested that PPH should be diagnosed in any patient who experiences postural headache at least once within 4 days of lumbar puncture.

Adolescent↗
PubMed2002

Disappearance of migraine attacks during long-lasting postdural puncture headache: a case report.

We report a patient with a history of frequent migraine attacks who developed postdural puncture headache that persisted for 3 months. His migraine attacks ceased during the period of his postdural puncture headache, but resumed 3 days after disappearance of that headache. This case suggests an interrelationship between the mechanisms of postdural puncture headache and migraine.

Adolescent↗