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PubMed1985

A comparison of speech using artificial larynx and tracheoesophageal puncture with valve in the same speaker.

Postlaryngectomy speech rehabilitation more frequently includes surgical-prosthetic methods since the introduction of a low morbidity tracheoesophageal puncture technique and a one-way airflow valve. This study compares speech using an artificial larynx and, in one case, esophageal speech with speech using a tracheoesophageal puncture and valve in the same speaker. Using nonprofessional listeners, speech was rated for intelligibility and preference. Voice spectrograms were employed for measurement of rate, fundamental frequency, and intensity. While no statistically significant differences were found in mean fundamental frequency or intensity, the rate of post-tracheoesophageal speech was considerably faster. In addition, when individual speakers are compared with themselves, post-tracheoesophageal speech is significantly more intelligible and preferred by naive listeners. We conclude that using the tracheoesophageal puncture with valve should be strongly considered in total laryngectomy patients whose present mode of communication is unsatisfactory.

Esophagus↗
PubMed1976

Clinical experience using a small-gauge needle for arterial puncture.

The present study was undertaken to ascertain the feasibility of using a 25-gauge needle for arterial punctures. A total of 11,500 arterial punctures were performed over the past four years by this technique without any major complication. Repeated arterial punctures were well tolerated by all patients, and the necessity for indwelling arterial catheters was almost totally eliminated during this period of study.

Arteries↗
PubMed2006

Hypotension and transient renal impairment induced by lumbar puncture.

INTRODUCTION: Raised intracranial pressure (ICP) may induce hypertension through sympathetic mechanisms. METHODS: Case report. RESULTS: A 55-year-old man was admitted with a symptomatic intracerebral mass and new refractory arterial hypertension. Several antihypertensive medications were necessary to control his blood pressure. A lumbar puncture was performed for diagnostic purposes and raised opening pressure (42 cm H2O) denoted raised ICP. After cerebrospinal fluid extraction, the closing pressure dropped to normal level. Shortly after the lumbar puncture, a sudden and pronounced drop in blood pressure was noted. Over the next day, the patient's serum creatinine rose from 0.9 to 1.9 mg/dL. Blood pressure normalized after discontinuation of all antihypertensive drugs and administration of intravenous fluids. Renal function also completely recovered within 2 days. The patient remained spontaneously normotensive thereafter. CONCLUSION: Sudden hypotension may occur after lumbar puncture in patients with raised ICP receiving treatment for arterial hypertension.

Acute Kidney Injury↗
PubMed1992

Anti-ovary antibodies after attempts at human in vitro fertilization induced by follicular puncture rather than hormonal stimulation.

Anti-ovary antibodies (AOA) have been detected in serum samples of women undergoing in vitro fertilization (IVF). High concentrations of these antibodies have been found in women who have had several IVF attempts and they appear to correlate with reduced chances of pregnancy. In this paper, AOA were assayed sequentially in a series of 140 IVF candidates to investigate the respective roles of hormonal stimulation and follicular puncture in inducing the autoimmune response. Serum was obtained 8 days after the beginning of ovarian human menopausal gonadotrophin (hMG) stimulation, then 15 days after follicular puncture. Significantly higher concentrations of IgG (P < 0.0001) AOA were observed in the second series of samples than in the first, suggesting that ovarian trauma and not hormonal stimulation is responsible for triggering antibody production. In the whole group, there was a negative correlation between IgM levels after puncture and oocyte numbers (P < 0.05). Among 'immune-responder' women, the concentrations of IgA AOA (P = 0.01) in the first sample, and of IgG (P = 0.01) or IgA AOA (P < 0.05) in the second, correlated with fewer oocytes after stimulation. There was no variation in the mean concentrations of AOA in women who achieved pregnancy.

Autoantibodies↗
PubMed2005

Transcutaneous cisternal puncture for sampling of cerebrospinal fluid in awake rat.

Reported cisternal puncture methods require the anesthetization and fixation of an animal within a stereotaxic frame. To determine the effect of anesthesia and animal fixation on the central nervous system (CNS), amino acid concentrations of cerebrospinal fluid (CSF) sampled by transcutaneous cisternal puncture were compared among awake rats, pentobarbital-anesthetized rats and pentobarbital-anesthetized rats fixed in a stereotaxic frame. Although the concentrations of many amino acids in the CSF of pentobarbital-anesthetized rats were lower than in awake rats, use of the stereotaxic frame resulted in significantly increased amino acid concentrations in the CSF. These data indicate that CSF sampling by transcutaneous cisternal puncture from awake rats is a suitable method for serial measurement of drug effects on the CNS.

Amino Acids↗
PubMed2006

Arterial puncture site management after percutaneous transluminal procedures using a hemostatic wound dressing (Clo-Sur P.A.D.) versus conventional manual compression: a randomized controlled trial.

PURPOSE: To investigate the efficacy and safety of a novel hemostatic wound dressing designed for rapid hemostasis at arterial puncture sites. METHODS: Over a 15-month period, 209 consecutive patients were randomized to conventional manual compression (n=105) or the use of the Clo-Sur P.A.D. hemostatic device (n=104) after removal of the sheath. Puncture-related and device-related complications, time to hemostasis, time to ambulation, and patient and physician discomfort were recorded. RESULTS: In 209 patients, 21 (10.0%) puncture-related complications were observed, including 11 (5.3%) pseudoaneurysms, 9 (4.3%) hematomas, and 1 (0.5%) major bleeding complication. There was no significant difference (p=0.36) in complications between the hemostatic device (9/104, 8.7%) and the conventional group (12/105, 11.4%). In the hemostatic device group compared to the conventional group, respectively, the average time to hemostasis (13.6 versus 20.3 minutes; p<0.001), time to ambulation (6.5 versus 17.4 hours, p<0.001), patient discomfort (VAS 2.1 versus 4.7, p<0.001), and physician discomfort (VAS 3.8 versus 5.2, p<0.001) were significantly lower. Twenty (19%) sheath removals in the hemostatic device group were classified as a technical failure of the device. CONCLUSION: The use of this hemostatic wound dressing for arterial access site management after percutaneous vascular procedures significantly reduced the time to hemostasis, enabled early mobilization, and reduced patient discomfort without increasing the risk for complications compared to conventional manual compression. A high rate of technical failures, however, warrants further improvement before routine use can be recommended.

Aged↗
PubMed1995

A new access site management tool: the Angio-Seal hemostatic puncture closure device.

PURPOSE: Given the increasing number of percutaneously applied endovascular therapies, the incidence of access-related vascular complications can be expected to rise, particularly in association with those techniques requiring large sheaths or anticoagulation. The need exists for a safe, easy to use, and effective hemostatic technique to replace the labor-intensive method of manual compression. METHODS: A bioabsorbable, sheath-delivered vascular device (Angio-Seal) has been developed that deposits a small collagen plug within the arterial wall to mechanically seal the puncture defect. An anchor connected by suture to the plug is first deployed in the arterial lumen and pulled flush against the interior wall to guard against intraluminal deposition of the collagen. RESULTS: The Angio-Seal device was deployed successfully in 80 (96%) of 83 attempts involving common femoral arteries accessed for peripheral angioplasty (n = 30), coronary angiography (n = 30), and coronary angioplasty (n = 16). Three popliteal artery access sites and one femoropopliteal bypass graft were also treated. Hemostasis was immediate in 78 cases (98%); 2 sites required a 5-minute manual compression to effect a secure seal. Three devices failed to deploy, and manual pressure was used to close the puncture. Nondeployment did not cause any sequelae, and no complications were encountered with the technique. CONCLUSIONS: This novel vascular closure device is quick (< 1 minute application time) and simple to use, providing a positive seal of common femoral artery puncture sites for both peripheral and coronary interventions. It appears to be a reliable alternative to standard manual hemostasis.

Angioplasty↗
PubMed1988

[Lateral cervical puncture for myelography and cerebrospinal fluid collection: technical note].

The lateral cervical puncture for myelography or cerebrospinal fluid collection is a modification of the technique of percutaneous cervical cordotomy. It may be performed at the atlanto-axial or atlanto-occipital interspace. It is simple to perform, and appears to be safer and more easily mastered than suboccipital puncture, with no more discomfort to the patient than that associated with lumbar puncture.

Atlanto-Axial Joint↗
PubMed2006

Transhepatic puncture of portal and hepatic veins for TIPS using a single-needle pass under sonographic guidance.

OBJECTIVE: Creating transjugular intrahepatic portosystemic shunts (TIPS) requires accessing a portal vein branch from a metal cannula wedged in a hepatic vein. This initial step in shunt creation often requires multiple blind intrahepatic punctures and occasionally fails. We describe a method using sonographic guidance to serially puncture the portal vein and hepatic vein with a single transhepatic needle pass, after which the TIPS procedure is completed in the standard transjugular fashion. CONCLUSION: Sonographically guided transhepatic dual puncture of the portal and hepatic veins facilitates portosystemic shunt creation in a single needle pass and allows more controlled selection of the portal vein entry and hepatic vein landing sites in selected patients.

Adult↗
PubMed2003

Ovarian function and morphology in the mare after multiple follicular punctures.

REASONS FOR PERFORMING STUDY: In the mare, ultrasound-guided transvaginal oocyte recovery and transfer might offer a way to circumvent the demanding procedures of in vitro embryo production. Before clinical application, the possible consequences for subsequent fertility have to be considered. OBJECTIVES: To examine ovarian function and morphology in mares after repeated follicular punctures. METHODS: A total of 14-26 follicular puncture sessions were conducted on each of 4 Norwegian pony mares over a period of 8 years. The ovaries of these mares were recovered by bilateral ovariectomy or at post mortem and subjected to macroscopic inspection and histology. For comparison, ovaries were collected from 7 nonaspirated control mares and processed for histology. RESULTS: In all experimental mares, ovarian function, defined as the ability regularly to ovulate preovulatory follicles and develop corpora lutea, remained normal during their last breeding season. Gross examination and histology showed that normal follicular and corpus luteum development was accompanied by the formation of condensed reparative fibrosis and normal local haemosiderosis of the ovarian stroma in all experimental mares. In one mare, an ovary contained several foci of chronic apostematous oophoritis, while a cystic structure lined with a single layer of epithelial-like cells and surrounded by a cartilaginous capsule was present in the other ovary. CONCLUSIONS AND POTENTIAL RELEVANCE: Repeated follicular aspirations do not hamper future folliculogenesis, ovulation and corpus luteum formation. However, ovarian puncture induces reparative fibrosis in the ovarian stroma and involves a risk of inducing abscess formation within the ovarian tissue which may impair fertility.

Animals↗
PubMed1990

Evaluation of pancreatic tissue fluid pressure measurements intraoperatively and by sonographically guided fine-needle puncture.

The aim of the present study was to evaluate the needle method for pancreatic tissue fluid pressure measurements. Clinical evaluation was performed in 24 patients with chronic pancreatitis, comparing repeated pressure measurements via sonographically guided fine-needle puncture and intraoperative pressure measurements by direct puncture of pancreatic tissue and duct. In patients with chronic pancreatitis we found small week-to-week variations in sonographically guided percutaneous pressure measurements and good agreement between preoperative percutaneous pressure measurements and intraoperative pressure measurements via direct puncture. Furthermore, no significant difference was seen between pancreatic duct and tissue fluid pressure. The technical evaluation was performed by repeated pressure measurements in human pancreatic autopsy specimens and living rats in a pressure chamber at various external pressure levels. The basic calibration of the method evaluated by means of this pressure chamber study showed sufficient precision and accuracy of the needle technique for clinical and investigative purposes. In conclusion, our results suggest that pancreatic tissue fluid pressure can be reliably assessed by the needle technique.

Animals↗
PubMedDate not supplied

Anterior stromal puncture in the treatment of loose epithelium after LASIK.

PURPOSE: To describe anterior stromal puncture, with or without a bandage contact lens, as a means to treat LASIK epithelial defects and potentially reduce the likelihood of secondary diffuse lamellar keratitis (DLK). METHODS: Six eyes of five LASIK patients had their microkeratome pass complicated by loose epithelium, central in one case. After repositioning the flap, a 25-gauge needle on a tuberculin syringe was used to puncture the anterior corneal stroma to just beneath Bowman's layer in the affected area of irregular epithelium. A bandage contact lens was placed on two eyes, including the one with loose epithelium centrally. RESULTS: Normal appearance of the corneal epithelium was noted by postoperative day 1; no eye developed DLK or significant epithelial ingrowth postoperatively. All eyes achieved > or = 20/20 vision. CONCLUSIONS: By obviating, in select cases, the need for bandage contact lenses, anterior stromal puncture could increase patient comfort and remove a potential source of infection.

Adult↗
PubMed1992

[Percutaneous renal cyst puncture and ethanol instillation].

Under ultrasound guidance 79 simple renal cysts in 65 patients were punctured and aspirated with our contrivance, a 5 Fr single J catheter on a 19 gauge needle. Forty-eight renal cysts were successfully punctured, that is, they had no bloody fluid and did not have any leakage of contrast medium. These cysts were instilled with absolute ethanol for 5 minutes. To follow up the patients, consecutive observation was done by sonography or CT every three months. Ethanol-instilled renal cysts were more markedly reduced (reduction rate: 93 +/- 17%) than not-instilled cysts (reduction rate: 32 +/- 28%). Thus, ethanol-instillation was useful in the reduction of renal cysts. After the puncture of cysts, hematuria disappeared in most patients.

Aged↗
PubMed2006

Lumbar puncture in neonates under and over 72 hours of age.

OBJECTIVE: To identify the criteria for performing a spinal tap in neonates with suspected sepsis and compare the findings in infants under and over the age of 72 hours. STUDY DESIGN: Analytical. PLACE AND DURATION: Neonatal Ward of Taleghani Medical Centre, Shaheed Beheshti University of Medical Sciences, Evin,Tehran. Study period was of one year, from March 2003 to February 2004. PATIENTS AND METHODS: All newborns subjected to a lumbar puncture during the first 24 hours of admission were enrolled in the study. Results of cerebrospinal fluid analysis were scrutinized. RESULTS: There were 380 neonates in the study. Majority i.e. 248 infants were aged<72 hours. Meningitis was diagnosed in 22 cases, (5.8%). There was no significant difference in the incidence of meningitis between neonates under and over 72 hours of age, (6.9% vs. 3.8%, p-value>0.5). Comparison of risk factors, clinical manifestations, and routine laboratory investigations revealed no significant difference in babies with or without meningitis. CONCLUSION: The findings of this series do not support a selective approach for performing a lumbar puncture in a possibly septic newborn. A lumbar puncture is recommended in all neonates with suspected sepsis regardless of age, risk factors, or specific neurological manifestations.

Age Factors↗
PubMed1999

[Arterial puncture or pulse oximetry?].

Arterial puncture is the general accepted standard method for monitoring oxygen therapy in critically ill patients, but this technique is painful for the patient, has the potential of complications, and does not provide immediate continuous data. Pulse oximetry is a non-invasive method used to measure arterial oxygen saturation with a clinically acceptable accuracy of +/- 2%. Despite some limitations, pulse oximetry is considered to be reliable in most cases in detecting hypoxaemia and monitoring oxygen therapy in stationary units. The pulse oximeter can reduce the number of arterial punctures, personnel's time consumption, and limit oxygen abuse. Furthermore the new transportable and hand-held pulse oximeters offer new possibilities for continuous 24 hour monitoring of oxygen saturation also out of hospitals. The pulse oximeter can optimize monitoring patients' oxygen saturation in the stationary units, however, arterial puncture will remain the most reliable method in the assessment of hypoxaemia and hypercapnia, especially in acute situations.

Arteries↗
PubMed1998

Extradural haematoma complicating lumbar puncture following a craniotomy. A case report.

BACKGROUND: This case report illustrates the development of an intracranial extradural haematoma (EDH) as an uncommon complication of a lumbar puncture. CLINICAL PRESENTATION: A 10-year-old girl operated for intra-third ventricular cysticercosis developed postlumbar puncture headache after a drainage lumbar puncture (LP) on the 7th postoperative day. CT scan revealed a right frontal EDH away from the operative site. INTERVENTION: The child was managed conservatively in view of her preserved sensorium. RESULTS: The child had an uneventful recovery. Follow-up CT scans showed resolution of the haematoma. CONCLUSIONS: LP, though considered to be a safe procedure, may rarely be associated with a potentially lethal intracranial haematoma, which can be managed successfully if diagnosed at an early stage.

Cerebral Hemorrhage↗
PubMed2000

Giant cervical epidural veins after lumbar puncture in a case of intracranial hypotension.

A 29-year-old woman presented with dilated epidural veins and incapacitating headache after undergoing a lumbar puncture. Two months later, the results of follow-up MR imaging were normal. These findings suggest that temporary dilation of the epidural vein may occur in association with post-lumbar puncture intracranial hypotension syndrome. In these cases, it seems useful to confirm whether the patient has recently undergone a lumbar puncture.

Adult↗
PubMed2001

Percutaneous suture closure for management of large French size arterial puncture in aortic valvuloplasty.

Percutaneous aortic valvuloplasty produces acute hemodynamic and clinical improvement in patients with aortic stenosis who are poor candidates for surgical valve replacement. The benefits of this procedure are mitigated by the high restenosis rates and 1--2 year mortality, in addition to significant vascular complications associated with the large arterial puncture necessary for retrograde arterial approaches. We describe the use of suture closure techniques to reduce the vascular morbidity associated with this procedure. We reviewed 31 consecutive patients who underwent percutaneous aortic valvuloplasty and suture closure with the Perclose device between April 1998 and September 2000. After diagnostic catheterization using 6--8 French (Fr) sheaths, an 8 or 10 Fr Perclose device was preloaded into the artery and the untied sutures left in place. A 12.5 or 14 Fr sheath was passed over the wire, through the sutures. The sutures were tied at the conclusion of the procedure, in conjunction with sheath removal. Twenty-seven out of 31 patients (87%) had successful suture closure of the arteriotomy and did not require prolonged bed rest, manual compression or a compression device. There were 4 failures of percutaneous suture closure, requiring conventional manual compression and bed rest for hemostasis. No patient required surgical repair of the arteriotomy, nor were there any limb complications. Compared to 39 consecutive prior patients who had their arterial puncture managed with manual compression, length of stay was shorter (2.2 days versus 5.3 days) and fewer patients received blood transfusions (0% versus 29%). Preloaded suture closure of the arterial puncture is a useful technique for achieving hemostasis after removal of the large sheaths used for percutaneous valvuloplasty, and reduces the post-procedure patient discomfort and prolonged bed rest associated with this procedure.

Aged↗