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At least 685 records · Page 38Linked to original sources
PubMed2000

Respiratory jugular venodilation: its anatomic rationale as a landmark for right internal jugular vein puncture as determined by ultrasonography.

OBJECTIVE: To reveal anatomic factors that determine the visibility of respiratory jugular venodilation, a landmark for right internal jugular vein puncture, in ventilated patients. DESIGN: Prospective observational study. SETTING: Single community hospital. PARTICIPANTS: Adult patients undergoing general endotracheal anesthesia. INTERVENTIONS: Anatomy of the right neck, including the carotid artery and internal jugular vein, was evaluated in a blind manner using 7.5-MHz ultrasonography in patients simulating the position for internal jugular vein puncture. Anatomic variables correlated with the visibility of respiratory jugular venodilation were analyzed. MEASUREMENTS AND MAIN RESULTS: Of 124 patients, respiratory jugular venodilation was observed in 94 patients (75.8%). Satisfactory quality of ultrasound image was obtained for all patients. The visibility of venodilation correlated with the extent of change of the vein size during a respiratory cycle but not with the end-expiratory or end-inspiratory vein diameter. These results indicated that there was no correlation between the vessel size and the visibility of venodilation, suggesting that it is rational to attribute the increased success rate of the respiratory jugular venodilation-guided puncture to accurate vein localization rather than to a larger target size. Among the demographic variables examined, body weight and obesity correlated with the visibility of venodilation, but age, gender, and height did not correlate. In obese patients, the respiratory change of the vein diameter was smaller, and the vein was deeper. CONCLUSIONS: The visibility of respiratory jugular venodilation does not correlate with the vein size but with the extent of its dynamic change during a respiratory cycle.

Adult↗
PubMed2002

Direct-puncture embolization of intraosseous arteriovenous malformation of jaws.

PURPOSE: Our goal was to report our experience with direct-puncture embolization of intraosseous arteriovenous malformations (AVMs). PATIENTS AND METHODS: Three cases of AVM in the mandible and 2 cases of AVM in the maxilla comprised this study group. The patients were embolized with fiber coils through direct puncture, and the coils were placed directly into the center of the intraosseous lesion, in some cases in conjunction with polyvinyl alcohol foam and N-butyl-2-cyanoacrylate through vascular access. RESULTS: The acute arterial bleeding was controllable in 3 patients. The other 2 patients had pericoronal oozing bleeding and a warm soft pulsative mass on the left face, respectively; their symptoms and signs improved greatly. The pericoronal oozing of blood in all patients disappeared during a 3- to 13-month follow-up, and new bone formation was found on the follow-up radiography. CONCLUSIONS: The embolization of the AVM of jaws by direct percutaneous puncture in conjunction with endovascular therapy is effective and safe, but longer follow-up is required to determine the true efficacy of this method of treatment.

Adolescent↗
PubMedDate not supplied

Microscopic analysis of three different spinal needle tips after experimental subarachnoid puncture.

BACKGROUND AND OBJECTIVES: Previous studies have shown the vulnerability of the tips of cutting type thin spinal needles and the possibility of foreign material passing into the subarachnoid space during the lumbar puncture. We made a microscopic analysis to compare two commonly used noncutting pencil-point spinal needles with different tip designs. Needles with a cutting tip design were included as reference. METHODS: Four fresh cadavers were placed in the lateral position and their backs were scrubbed with disinfectant solution containing 0.1% fluorescein. Thirty-two spinal needles (27 gauge) of each type (modified Quincke, modified Sprotte, and modified Whitacre) were inserted through an introducer at interspaces L2-5 into the subarachnoid space. Under visual control (spinal canal opened ventrally) all the needle tips were cut after successful subarachnoid puncture; 16 needles of each tip design were investigated under a fluorescence microscope, and another 16 needle tips were collected into test tubes and cytocentrifuged smears were prepared. The tips and smears with the most obvious findings were photographed under a microscope. RESULTS: On microscopy, only 2 needle tips were damaged (1 modified Quincke and 1 modified Whitacre). Visible fluorescent tissue particles were more frequently seen on modified Quincke needles (56%) compared with modified Sprotte (37%) and Whitacre (37%) needles (NS). In the cytocentrifugation smears, the largest clusters of epithelioid cells and muscle fibers were observed in the Quincke group. In the Whitacre group many fewer and smaller cell clusters including small muscle particles were seen, and only minor epithelioid cells were found in the Sprotte group. CONCLUSIONS: Tissue coring seems to be a common phenomenon during lumbar puncture. The most prominent attachments appeared with a cutting Quincke-type spinal needle.

Adult↗
PubMed1977

[Fine needle puncture for antegrade pyelography and percutaneous nephropyelostomy (author's transl)].

A method for antegrade pyelography and pyelonephrostomy is described using a long, thin needle with a shorter, wider Seldinger cannula. Puncture with a thin needle reduces the risk during antegrade demonstration of the upper urinary tract and can also be used for puncturing collecting systems which are only slightly dilated. When necessary, the Seldinger cannula can be advanced over the needle; subsequently, with the aid of a J-wire, a nephropyelostomy can be performed. The method has been used in 20 patients. In one case of intended bilateral nephropyelostomy the puncture was successful on only one side. There were no serious complications. In only one patient a small perirenal haematoma was found at operation.

Catheterization↗
PubMed1992

[Use of collagen in sealing of arterial puncture holes after heart catheterization].

Percutaneously introduced absorbable purified bovine collagen was used to plug the hole at the site of femoral arterial puncture in 50 patients (42 men, 8 women; median age 58 [22-75] after percutaneous coronary angiography (n = 32; heparin dosage 100 IU/kg) or transluminal coronary balloon dilatation (n = 18; heparin dosage 200 U/kg). Local bleeding ceased after compression of 4 min in 48 of the 50 patients. A pressure bandage was needed additionally in the other two. Bed-rest lasted for 1-24 (median 19) hours. A haematoma of more than 6 cm diameter developed in five patients, but required neither transfusion nor surgical intervention. 39 of the 50 patients were re-examined after a median of 39 days: all of them had had a small pain-free swelling for 2-6 weeks over the puncture site. One patient developed a deep-vein thrombosis one week after the procedure, in another fever occurred after the same period, lasting for two days. These early findings are encouraging. The method may significantly shorten the time of arterial compression and bed-rest, as well as reduce the risk of a large haematoma after arterial punctures.

Adult↗
PubMed2001

Computed tomography of the head before lumbar puncture in adults with suspected meningitis.

BACKGROUND: In adults with suspected meningitis clinicians routinely order computed tomography (CT) of the head before performing a lumbar puncture. METHODS: We prospectively studied 301 adults with suspected meningitis to determine whether clinical characteristics that were present before CT of the head was performed could be used to identify patients who were unlikely to have abnormalities on CT. The Modified National Institutes of Health Stroke Scale was used to identify neurologic abnormalities. RESULTS: Of the 301 patients with suspected meningitis, 235 (78 percent) underwent CT of the head before undergoing lumbar puncture. In 56 of the 235 patients (24 percent), the results of CT were abnormal; 11 patients (5 percent) had evidence of a mass effect. The clinical features at base line that were associated with an abnormal finding on CT of the head were an age of at least 60 years, immunocompromise, a history of central nervous system disease, and a history of seizure within one week before presentation, as well as the following neurologic abnormalities: an abnormal level of consciousness, an inability to answer two consecutive questions correctly or to follow two consecutive commands, gaze palsy, abnormal visual fields, facial palsy, arm drift, leg drift, and abnormal language (e.g., aphasia). None of these features were present at base line in 96 of the 235 patients who underwent CT scanning of the head (41 percent). The CT scan was normal in 93 of these 96 patients, yielding a negative predictive value of 97 percent. Of the three misclassified patients, only one had a mild mass effect on CT, and all three subsequently underwent lumbar puncture, with no evidence of brain herniation one week later. CONCLUSIONS: In adults with suspected meningitis, clinical features can be used to identify those who are unlikely to have abnormal findings on CT of the head.

Adolescent↗
PubMed2001

Use of hypnosis in controlling lumbar puncture distress in an adult needle-phobic dementia patient.

Lumbar punctures are often vital to the medical management of patients with suspected organic pathology, yet they are commonly met with such distress that medical risk is significantly increased, and patient rapport is significantly decreased, further compromising medical treatment. Although the use of hypnosis for lumbar punctures is well established in pediatric patients, no literature exists for adult patients. Similarly, there is no extant research regarding hypnosis for dementia patients, likely due to the limiting factors of impaired attention and concentration. With these factors in mind, a method for incorporating hypnosis into a lumbar puncture procedure is described for a needle-phobic adult patient suffering from dementia.

Dementia↗
PubMed1996

Simultaneous lumbar and intraventricular manometry to evaluate the role and safety of lumbar puncture in raised intracranial pressure following subarachnoid haemorrhage.

We report a prospective investigation of a bedside test to evaluate the role and safety of lumbar puncture in raised intracranial pressure in patients with subarachnoid haemorrhage. Fourteen patients who underwent aneurysm clipping following subarachnoid haemorrhage were studied. All patients had intraventricular drains and needed high volume cerebrospinal fluid (CSF) drainage to maintain the normal intracranial pressure. A lumbar puncture was performed in these patients and the simultaneous opening lumbar and ventricular pressures noted, CSF was then drained via the lumbar puncture, and the simultaneous closing lumbar and ventricular pressures noted. In all patients, the opening lumbar pressure was close to the ventricular pressure. In 13 of 14 patients, CSF drainage resulted in an equivalent and simultaneous fall of ventricular pressure. We concluded that simultaneous measurement of lumbar and ventricular CSF pressure before and after lumbar CSF drainage allows identification of candidates with differential cranial and lumbar pressures and therefore indicates safety or risk of lumbar CSF drainage.

Cerebral Ventricles↗
PubMed1997

MR-guided joint puncture and real-time MR-assisted contrast media application.

OBJECTIVE: To develop, in MR arthrography of the shoulder joint, an MR-guided technique for localizing the needle puncture and confirming the intracapsular needle-tip position by visualization of the contrast media inflow. MATERIAL AND METHODS: Three unfixed human shoulder specimens were examined on a 1.0 T MR unit. On the basis of MR-compatible markers, the optimal entrance point for puncturing the joint was determined. The precise localization of the needle tip (MR-compatible 0.7-mm needle) in the shoulder joint was determined with rapid localizer GRE sequences in 2 orthogonal planes. To confirm the intracapsular position of the needle tip, diluted Gd-DTPA was applied via a long connecting tube and contrast medium inflow into the joint space was controlled on an LCD screen in real-time MR imaging (local-look technique). RESULTS: MR-compatible markers on the skin allowed the rapid determination of the optimal entrance point for needle puncture. An adequate localization of the intra-articular needle-tip position was possible in all specimens although significant artifacts were present on rapid localizer GRE sequences which resulted in an increase in the apparent width of the needle shaft. Real-time MR imaging of the contrast medium inflow was made possible by the local-look technique and LCD screen on the MR unit and this allowed confirmation of the intracapsular position. CONCLUSION: In MR arthrography of the shoulder, an MR-guided technique in conjunction with the LCD screen and real-time MR imaging would seem to be a practical alternative to conventional fluoroscopic guidance.

Artifacts↗
PubMed1997

The first lumbar puncture.

In this article it is argued that Heinrich Irenäus Quincke who should be credited with the discovery of lumbar puncture. Although some authors mention the names of James Leonard Corning and Walter Essex Wynter as well, it is demonstrated, by comparing the relevant publications, that the discovery, the application for diagnostic purposes and the introduction in clinical practice of the lumbar puncture were done by Quincke. At first, the purposes for performing a lumbar puncture were purely therapeutic, for instance CSF-drainage in hydrocephalus and meningitis. But, soon after, it was applied for diagnostic aims as well.

Germany↗
PubMed2002

Transrectal ultrasound-guided puncture, drainage, and minocycline hydrochloride sclerotherapy for the symptomatic prostatic cyst.

PURPOSE: We treated three patients who had symptomatic prostatic cysts by transrectal ultrasound-guided puncture, drainage, and sclerotherapy. The procedure and the results are described in this report. MATERIALS AND METHODS: The patients were 60, 73, and 78 years old and complained of difficult voiding. With local anesthesia, transrectal ultrasound-guided puncture and drainage were performed, and then 100 mg of minocycline hydrochloride was infused into the cavity of the cyst. We evaluated the International Prostate Symptom Score (IPSS), urodynamic data, volume of residual urine, complications, and recurrence. RESULTS: There were no complications, and improvements of voiding symptoms were experienced without any recurrences within the 2 years or more of follow-up. CONCLUSION: This minimally invasive treatment by transrectal ultrasound-guided puncture, drainage, and minocycline hydrochloride sclerotherapy is suggested to be promising for the symptomatic prostatic cyst.

Aged↗
PubMed2004

Re-endothelialization of punctured ePTFE graft: an in vitro study under pulsed perfusion conditions.

BACKGROUND: When used as arteriovenous (AV) shunts for haemodialysis, small diameter expanded polytetrafluoroethylene (ePTFE) grafts have a high failure rate in vivo. Attempts to improve graft patency are various, and focus on either improvement of implantation techniques or graft tissue engineering. The tissue engineering approach attempts to reproduce in grafts the properties of pristine vasculature. As shown in previous experiments, it is possible to grow on ePTFE grafts under shear stress in vitro an autologous endothelial cell layer, which will withstand physiological stress under in vivo conditions of blood flow. The aim of this study was to investigate in an in vitro model the regenerative potency of a tissue-engineered prosthetic vascular graft after repeated cannulation with a haemodialysis cannula. METHODS: Pig endothelial cells were harvested from an external jugular vein. Following processing of the endothelial cells, seven ePTFE grafts were coated with an inner cell layer and were kept under pulsed perfusion. Each graft was then cannulated three times with a standard shunt needle. The endothelium was then left to regenerate for a maximum of 48 h. The grafts were stained with haematoxylin/eosin before histological study. RESULTS: All grafts were endothelialized over the puncture sites within 48 h. Histological analysis revealed a confluent endothelial cell lining at each puncture site. Cell morphology and cell pattern over puncture sites were not different from randomly picked locations over the graft lumen. CONCLUSION: Our results underline the potential of endothelial tissue engineering in vascular shunt surgery. Vascular bio-hybrids that have the properties of pristine vascular endothelium may be a key step forward in maintaining angio-access in patients who require haemodialysis.

Animals↗
PubMed1986

Trans-vaginal oocyte retrieval using a trans-vaginal sector scan probe combined with an automated puncture device.

A new trans-vaginal sector scanning ultrasound probe has been developed providing a forward viewing sector of 240 degrees. Due to its rotating one-beam scanner, the images of the uterus and the ovaries with their follicles are of high resolution and are clearly outlined on the screen. An automated puncturing device has been adjusted to this probe which gives the surgeon more precision in placing the tip of an aspiration needle into the middle of the follicle. This combination of a trans-vaginal ultrasound probe with an automated puncturing device for aspirating oocytes for in-vitro fertilization avoids the need for a full urinary bladder, with less discomfort for the patients and permits easy orientation because the organs of the pelvis are within a close range. More accurate follicular punctures can thus be performed. First experiences with 40 oocyte retrievals revealed that 79% of oocytes were recovered and the incidence of clinical pregnancy was 17.5%.

Female↗
PubMedDate not supplied

Epidemiology of accidental needle-puncture wounds in hospital workers.

All employees, including physicians, of a 450 bed hospital were monitored for puncture wounds from contaminated needles over a four-year period. Five hundred seventy-nine incidents were reported. Nurses were involved in 66% of instances, housekeeping 16%, laboratory workers 10%, physicians 4% and x-ray technicians 4%. Many puncture wounds were avoidable, suggesting the need for ongoing employee education. In 67% of the injuries blood from the patient in whom the needle had been used was tested for HBsAg; 1% of those tested were positive. In such instances, employees were given immune globulin. These data indicate that needle puncture wounds are a frequent problem for hospital workers, and carry a risk for transmitting hepatitis B. Efforts to prevent such injuries are needed.

Accidents, Occupational↗
PubMed1998

In vitro investigation of cerebrospinal fluid leakage after dural puncture with various spinal needles.

UNLABELLED: Postspinal headache is one of the most common complications of spinal anesthesia and has repeatedly led to controversy concerning needle size and configuration. In an in vitro investigation, we measured cerebrospinal fluid (CSF) leakage with Sprotte, Whitacre, Quincke, and Atraucan needles under physiological conditions in human dura. The puncture characteristics were examined under an electron microscope. The pencil-point needles show 2-3 times less leakage of CSF compared with the cutting Quincke needles of corresponding size. Between the Sprotte and the Whitacre needles, there were no significant differences. The least loss of CSF occurred with the 26-gauge Atraucan needle. Under the electron microscope, a sharply delineated, persistent perforation channel was shown with the Quincke needles, which may explain the high CSF loss. With pencil-point needles, which push the tissue apart bluntly, a large opening on the inside is found, with some tearing of the dura. However, in contrast to the cutting needles, a persistent perforation channel is not manifested. The 26-gauge Atraucan needle, which both cuts and pushes apart conically, shows a relatively discrete opening on the inside, with slight tears in the dura and arachnoidea but without a visible perforation channel. The results of our study show that larger needles (26-gauge Atraucan) that are easier to handle can lead to good and, in some cases even better, puncture results if they have characteristics of both the cutting and the pencil-point needles. IMPLICATIONS: We compared several brands of pencil-point and standard cutting spinal needles of varying sizes. All pencil-point needles had less cerebrospinal fluid leakage, the least loss occurring with 26-gauge Atraucan needles. Electron microscopic examination of the dura after puncture showed characteristic findings with each needle type. We conclude that the combined cutting and pencil-point characteristics seen in the Atraucan needle may have clinical advantages.

Cerebrospinal Fluid↗
PubMed1989

Needle bevel direction and headache after inadvertent dural puncture.

To study the effect of needle bevel direction on the incidence and severity of headache following inadvertent dural puncture occurring during the identification of the epidural space, the authors randomly assigned obstetric anesthesia residents to identify epidural space with the bevel of the epidural needle oriented either parallel or perpendicular to the longitudinal dural fibers. If dural puncture occurred, an observer unaware of the needle bevel direction, daily assessed the presence and severity of any subsequent headache. Of the 1,558 women who received epidural analgesia during this study, 41 women suffered dural puncture, 20 with the needle bevel oriented perpendicular to the longitudinal dural fibers and 21 with the needle bevel inserted parallel to the dural fibers (NS). Fourteen of 20 women in the group in which the needle bevel was perpendicular to dural fibers developed a moderate to severe headache, whereas only five of 21 in the group in which the needle bevel was parallel to dural fibers did so (P less than 0.005). Similarly, we administered a therapeutic blood patch to ten of 20 women in the perpendicular group but to only four of 21 in the parallel group (P less than 0.05). Thus, identifying the epidural space with the needle bevel oriented parallel to the longitudinal dural fibers limits the size of the subsequent dural tear and, therefore, lowers the incidence of headache should dural perforation occur.

Analgesia, Epidural↗
PubMed2006

Gender and post-dural puncture headache.

Gender is believed to be an independent risk factor for the development of post-dural puncture headache, but there are some of the inconsistencies in the available data. This systematic review examined a total of 18 trials (2,163 males, 1,917 females). The odds of developing a post-dural puncture headache were significantly lower for male than nonpregnant female subjects (odds ratio = 0.55; 95% confidence interval, 0.44-0.67). Although the authors found that nonpregnant female subjects seem to have a higher incidence of post-dural puncture headache than males, the etiology behind these findings is not clear from the current meta-analysis.

Adult↗
PubMed2001

Intracranial subdural hematoma after puncture of spinal meningeal cysts.

A patient is reported with an intracranial subdural hematoma after puncture of spinal meningeal cysts. In this case, spinal meningeal cysts were diagnosed by myelography. No intracranial subdural hematoma was detected immediately after myelography. Deterioration in the patient's level of consciousness occurred after puncture of the cysts. The authors speculated that the cerebrospinal fluid pressure dropped rapidly when the spinal meningeal cysts were punctured. This displaced the cerebral bridging veins downward, tearing them and resulting in an intracranial subdural hematoma.

Central Nervous System Cysts↗